DoD Needs "Different Kind" of Health Care, Leader Says
By Douglas J. Gillert
American Forces Press Service
WASHINGTON, Feb. 9, 1999 A fit fighting force and healthy population require a different kind of health care system, one of DoD's top physicians said here Feb. 4.
"The classic medical view is, when you're ill, come to the emergency room and we'll give you stuff," Air Force Dr. (Lt. Gen.) Charles Roadman II said at the 1999 TRICARE Conference. "We will get you back to health, and then when you're sick again, come back and we will do the same thing."
But factors such as escalating health care costs and the changing military mission that puts a premium on readiness demand a new system that concentrates more on prevention than intervention, said Roadman, the Air Force surgeon general and DoD executive agent for preventive health programs. Such change, he said, will require a partnership between military leaders, medics and the DoD population in general.
Health care costs have reached crisis levels, Roadman said, and medical treatment of preventable diseases and injuries drains the health budget. One out of eight deaths in DoD hospitals are due to tobacco, and 3 percent are alcohol-related, he said.
"In 1995, we spent $1.3 billion for cigarette-related illness out of a $14.5 billion budget," he said.
"Not only is it the human cost, but it is also the national and federal and DoD capital we're spending, while we transmit dual messages in our communities." Roadman was talking about DoD treating patients for tobacco- and alcohol-related diseases while military stores sell discount cigarettes and booze. "We have to become coherent in our approach to what the messages are to our people," he said.
Besides life-style diseases, unintentional injuries also plague health care costs, Roadman said. The rising percentages of hospital admissions and outpatient treatment for injuries are due to unsafe practices in the work place, he said. Beyond treatment, that isn't a medical problem, he said.
"The problem is out in the work places where the commanders, first sergeants and supervisors are responsible," he said. He cited hearing loss and repetitive trauma -- carpal tunnel syndrome, for example -- as major work place problems and said DoD must shift resources from treatment to prevention.
The current medical system is ill-prepared to deal with these and other preventable health problems, he said, adding, "It's going to require us to look at our population and understand all the risks. If we are going to have a system that delivers something different, we need to do something different."
Today's health care requirements evolved from a cottage industry that treated single patients and provided no continuity of care, Roadman said. Using a model designed by British cardiologist Nigel Roberts, Roadman traced the growth of medicine through three levels.
"If you look at the patient only, it's an acute, episodic, sickness-based, repair and restore model," he said. "There was no patient before he came into the room, there is no patient afterward, but it's the most important thing as he sits across from my desk."
The next -- and current -- level involves all patients in a health care system, he said. Here, medical systems look at the management of facilities and cases and seek efficient ways to care for specific diseases. "That is still disease management -- doing the same thing harder," Roadman said.
It's not until the health care system looks at entire population that it begins to think in terms of actively involving communities in health care, he said. "'Suicide' [hazardous life styles] is not a medical problem, it is a community problem," he said. "Carpal tunnel [syndrome] is a commander, first shirt, supervisor [and] work place problem."
Roadman said the new health care model encompasses resilient communities taking care of their people. He said it means understanding the health risks of specific population groups, by age, sex, race and occupation. He said the Military Health System must identify population-based health care requirements and what communities can do to prevent disease and injury. "That's the only way we can begin to get into health status improvement," he said. "It's only through health status improvement that we start to get to a fit fighting force and a 'fit fighting' dependent population.
"We have the right tools, but we don't have the necessary design and plan to get into this," Roadman said. "We have to put basic fundamental practices of quality and fact-based decision making into our health care system, so that we begin with the end in mind.
"The end in mind ought to be where we have a patient population that says, 'I cannot imagine having to go to any other health care system, because I know I won't get the caring and the care that I get in the Military Health System.'"
Roadman urged the TRICARE providers to "take off all the fetters and dream. Dream about what it could be, not what it is today. The dream that we have is like a phoenix," he said. "It is going to rise out of the old system. You cannot have the old system and the new system existing together."