Reaching a better management model for military medicine.

Despite the attempt by some to condemn it because of the unfortunate experience of some service members at Walter Reed Army Medical Center, military medicine has long provided healthcare coverage to legions of soldiers during both war and peace. Since 1884, the U.S. Congress has also required that military medicine provide healthcare treatment free of charge to the families of officers and soldiers. The unforeseen consequence of this Congressional action is that today, military medicine provides medical care to a population of families and retirees that is 4 times larger than the active duty force that it supports. Unable to do so on its own, the Department of Defense hired managed-care support contractors to help create the TRICARE health plan to improve access to healthcare for these families and retirees and to take advantage of capabilities of the managed-care industry. By most accounts, TRICARE has been successful. It is, however, anchored by the military treatment facilities, Walter Reed among them, which need a revolution in management. This article explores these aspects of military medicine.