LAUSR

In the last two decades, the U.S. Military Health System (MHS) has achieved unprecedented success in overseas missions—especially toward improving the delivery of critical care and accomplishing the highest survival rates in combat. These achievements have been lauded as a framework that can improve the practice of medicine in the U.S. At the same time, the U.S. MHS has come under intense scrutiny over the costs and quality of their services within the country. This dichotomy is a consequence of the dual role that the MHS plays: while one of them is delivery of medical care in combat situations, the other is caring for members of the military service and their families at home. Although the achievements for overseas missions are recognizable, the health system at home has been deemed inefficient and expensive. Currently, members of the military services, retirees, and their dependents receive medical care in a variety of clinical settings. On one side is “direct care” where clinical services are provided directly at military treatment facilities (MTFs) by salaried military providers and contractors, whereas on the other side is “purchased care” where clinical services