Military Health

How does the VA outperform other systems in the delivery of patient care? In its 2001 report “Crossing the Quality Chasm,” the Institute of Medicine called for systematic reform to close the quality gap in U.S. healthcare. Recommended reforms included the development of a health information technology infrastructure, a performance monitoring system, and methods to … Read more

U.S. Military Suicide Prevention The casualties of the wars in Iraq and Afghanistan are well known. But another cost has emerged: soldier stress, which can manifest itself in different ways. One of the most troubling manifestations is suicide, which has increased among U.S. soldiers over the past decade. In response, the U.S. Department of Defense … Read more

The Health Behavior Survey (HRBS) is a primary survey conducted by the U.S. Department of Defense (DoD) to learn about the health, health-related behaviors, and well-being of service members. The HRBS has been conducted periodically for more than 30 years and covers areas that may affect military readiness or the ability to meet the demands … Read more

The U.S. Department of Defense (DoD) has traditionally provided health benefits to active and retired military personnel and their families. Active duty personnel who retire after 20 or more years of service are entitled to continue to receive medical benefits for themselves, their spouses, and dependent children through the military health care plan (TRICARE). However, … Read more

With the support of public and private organizations, extensive and often costly research is being conducted on a variety of topics, including health, education, and production practices. This may relate to basic science or be more applied. Determining whether research is producing tangible benefits is a complex problem. There can be a long period of … Read more

Findings of New Cross-Over Surveys As the United States withdraws troops from Iraq and Afghanistan and more soldiers return to civilian life, the military health care system must identify and manage the physical and psychological effects of war, which can persist long after deployment. Among military personnel, comorbidities are common and are associated with an … Read more

Does VA have the necessary forecasting tools? In 1996, the responsibilities of the Department of Veterans Affairs (VA) expanded significantly. The Veterans Health Care Reform Act of 1996 transformed the delivery of health care to veterans from an episodic provider of hospital care for veterans to a comprehensive health care provider covering all the medical … Read more

Behavioral health technicians are military personnel who work alongside licensed mental health providers such as psychiatrists, psychiatric nurses, psychologists and social workers. They are caregivers who help the military health system (MHS) streamline and improve the delivery of behavioral health care. BHTs perform a wide range of duties in garrison and operational settings, including clinical … Read more

A New Strategy for Supporting Combat Hospitals The U.S. Army uses CSHs – mobile hospitals built in tents and extendable containers – to provide surgical and trauma care close to the battlefield. The CSH unit includes a 248-bed hospital, about 500 personnel and $26 million worth of medical equipment. There are 26 CSH units in … Read more

The Health Behavior Survey (HRBS) is a primary survey conducted by the U.S. Department of Defense (DoD) to learn about the health, health-related behaviors, and well-being of service members. The HRBS has been conducted periodically for more than 30 years and covers areas that may affect military readiness or the ability to meet the demands … Read more

Reservists are an integral part of the U.S. military and are constantly called upon to support operations around the world. Since September 2001, more than 800,000 reservists have been voluntarily and voluntarily called to active federal duty. Reservists in each unit are responsible for ensuring that reservists are not only properly equipped and trained, but … Read more

Confidentiality is the cornerstone of effective mental health care. Few physicians and patients dispute this. Our patients’ problems are very personal and private. Wherever we practice medicine in mental health clinics, our practices are filled with pain points in which protracted wars are waged against enormous personal problems. In civil law, the rules of confidentiality … Read more

Today’s soldiers, sailors, Marines, airmen and Coast Guardsmen face unprecedented stresses, including repeated and prolonged deployments to hostile environments, far from home and far from friends and family. The media, journalists, politicians, military leaders and, perhaps most importantly for readers of the NCFR report, genealogists have reported on these stresses. Family researchers-including social workers, psychologists, … Read more

The Health Behavior and Behavior Survey (HRBS) is the US Department of Defense’s (DoD) primary survey of the health, health behaviors and well-being of military personnel. The HRBS, which has been conducted regularly for more than 30 years, covers areas that may affect military readiness or the ability to meet the demands of military life. … Read more

The HRBS is the U.S. Department of Defense’s (DoD) flagship study of the health, health-related behaviors and well-being of military personnel. The HRBS has been conducted regularly for more than 30 years and covers areas that may affect military readiness or the ability to meet the demands of military life. The Department of Defense Office … Read more

Employees may become injured or ill in the performance of their duties so that they are unable to perform their duties. In these situations, the hired person may be referred for a disability evaluation to determine whether his or her condition is such that he or she can return to work or whether it is … Read more

Implementation of cooperation protocols Although military installations are separated from surrounding communities in various ways, they are not islands. Military personnel and their families regularly visit these communities, and many live off installation. Domestic violence that occurs off installation is the responsibility of local civilian authorities. In fact, civilian authorities may also have jurisdiction (and … Read more

The Health Behavior and Behavior Survey (HRBS) is the US Department of Defense’s (DoD) primary survey of the health, health behaviors and well-being of military personnel. The HRBS, which has been conducted regularly for more than 30 years, covers areas that may affect military readiness or the ability to meet the demands of military life. … Read more

The way how young soldiers and their spouses cope with deployment The mental and emotional problems of U.S. soldiers deployed to the conflicts in Iraq and Afghanistan are well documented (see for example The Invisible Wounds of War). However, there is evidence that military families suffer as well, particularly from the stress of multiple and … Read more

Between March 14 and 18, 2005, possible anthrax incidents occurred at three Department of Defense (DoD) postal facilities in Northern Virginia and Washington, D.C.: the Pentagon’s Remote Delivery Facility (RDF), the TRICARE Management Activity (TMA) complex at Skyline Towers, and the Defense Intelligence Agency (DIA). The Department of Defense responded to the events in collaboration … Read more

The Health Behavior and Behavior Survey (HRBS) is the US Department of Defense’s (DoD) primary survey of the health, health behaviors and well-being of military personnel. The HRBS, which has been conducted regularly for more than 30 years, covers areas that may affect military readiness or the ability to meet the demands of military life. … Read more

The Health Behavior and Behavior Survey (HRBS) is the US Department of Defense’s (DoD) primary survey of the health, health behaviors and well-being of military personnel. The HRBS, which has been conducted regularly for more than 30 years, covers areas that may affect military readiness or the ability to meet the demands of military life. … Read more

Current RAND Policy Studies and Literature Reviews Veterans of the 1991 Gulf War have reported a wide range of physical and psychological symptoms, some of which remain unexplained. In order to make every effort to understand and explain the illnesses, educate veterans and the public, and recommend changes in Department of Defense (DoD) policies and … Read more

There are currently 5.5 million men and women in the United States who assist a current or former employee with a disabling injury or illness. We call these men and women military caregivers. They are our country’s unsung heroes: their support keeps veterans out of institutions and helps them live longer and better lives. All … Read more

New York State Example The U.S. Department of Veterans Affairs (VA) is responsible for the government’s obligation to provide health care to U.S. veterans. However, not all veterans are eligible for VA care. In addition, veterans who are eligible for veterans’ care often rely on multiple sources, including veterans’ care paid for by the VA … Read more

Support for Soldiers and Their Families in Civil Life Since 2001, an unprecedented number of National Guardsmen and Reservists have been deployed to key missions in foreign operations. More than 800,000 Reservists have been called to active duty since September 11, 2001. These increased requirements have resulted in an increasing number of recruits and reservists … Read more

Between 2002 and 2017, more than 200,000 active duty U.S. military personnel were diagnosed with post-traumatic stress disorder (PTSD) and nearly 300,000 with traumatic brain injury (TBI). These conditions became famous with the wars in Afghanistan and Iraq, where more than 3 million soldiers were deployed to support combat operations. The physical and psychological stress … Read more

New Ideas Since the creation of the all-volunteer military in the 1970s, military support programs have grown and continue to grow. A 1988 Department of Defense (DoD) directive requires that these programs meet the needs of service members and their families. Unfortunately, DoD does not have a systematic method for determining these needs. Traditional program … Read more

Caregivers: You’ll never walk alone A RAND study estimates that there are 5.5 million people in the United States who provide informal care for veterans with debilitating injuries or illnesses. These people – we call them military caregivers – are the spouses, parents, siblings, friends, neighbors and children of our nation’s veterans. They play an … Read more

The Health Behavior and Behavior Survey (HRBS) is the US Department of Defense’s (DoD) primary survey of the health, health behaviors and well-being of military personnel. The HRBS, which has been conducted regularly for more than 30 years, covers areas that may affect military readiness or the ability to meet the demands of military life. … Read more

The 2018 National Defence Strategy showed that the global security environment and the nature of the threats that the United States must prepare for in future combat operations have changed. Unlike counterinsurgency or counterterrorism operations of recent years, the Strategy prioritises the preparation for a large-scale, rapid interstate conflict. Potential adversaries – such as China, … Read more

Last night, President Donald Trump delivered the final State of the Union address of his four years in office. The speech came between Monday’s first race in Iowa to nominate his general election opponent and this afternoon’s expected Senate vote on whether to impeach the president. These unprecedented circumstances are likely to form the lens … Read more

Brain injury has been described as a typical injury of modern warfare. Between 30% and 50% of injuries sustained in the recent conflicts in Iraq and Afghanistan were caused by improvised explosive devices, and TBIs are often the result of these events. However, the majority of concussions occur when service members are off duty and … Read more

When U.S. soldiers, sailors and Marines are wounded in the wars in Iraq and Afghanistan, they receive the best medical care in the world. When these wounded soldiers recover and eventually leave the hospital, the responsibility for their care and support shifts to their spouses, parents, children and loved ones. Little is known about the … Read more

The Health-Related Behavior Survey (HRBS) is the U.S. Department of Defense’s (DoD) primary survey designed to gain insight into the health, health-related behaviors, and well-being of military personnel. The HRBS has been conducted regularly for more than 30 years and covers areas that may affect military readiness or the ability to meet the demands of … Read more

Two years ago on Memorial Day, I wrote: “There is no better way to honor the men and women who have died by suicide – and their remaining families and friends – than to ensure that the State does all it can to prevent future untimely deaths.” This message is especially important this year as … Read more

Improving the quality of care for service personnel with PTSD and depression Healthy and fit troops depend on the physical and mental readiness of each service member. Untreated post-traumatic stress disorder (PTSD) and depression can have a significant impact on troop readiness. The Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, part … Read more

The Health and Behavior Survey (HRBS) is the US Department of Defense’s (DoD) primary survey of the health, health behaviors and well-being of military personnel. The HRBS, which has been conducted regularly for more than 30 years, covers areas that may affect military readiness or the ability to meet the demands of military life. The … Read more

Ensuring excellent treatment of PTSD and depression in the military Post-traumatic stress disorder (PTSD) and depression are common and treatable mental health problems. Without proper treatment, these diagnoses can have a significant impact on soldiers and their families, but little is known about the quality of care provided by the military health system (MHS). To … Read more

The Health-Related Behavior Survey (HRBS) is the US Department of Defense’s (DoD) primary survey of the health, health behaviors and well-being of military personnel. The HRBS, which has been conducted regularly for more than 30 years, covers areas that may affect military readiness or the ability to meet the demands of military life. The Department … Read more

Military Caregiver Curriculum The Elizabeth Dole Foundation asked the RAND Corporation to develop a research agenda to guide future efforts to improve support for military caregivers and veterans. To develop the plan, researchers mapped currently available research on caregiving for adults, children, and older adults with disabilities and gathered stakeholder input through a survey and … Read more

Three main priorities The primary goal of the military health system (MHS) is to ensure that soldiers suffering from behavioral disorders, such as post-traumatic stress disorder (PTSD), depression and substance use disorders, receive effective treatment. Soldiers who live geographically far from a military treatment center may have particular difficulty accessing quality care, which can compromise … Read more

Sycophants may ask, “Why should I care?” It’s a reasonable question, and that’s where we start. Each of you is a scarce resource for our society at large. If your bandwidth is like mine, it fills up fast and there’s a limit to what it can digest and what it can handle. So here are … Read more

The mental health and cognitive health care needs of veterans Since October 2001, some 1.64 million US troops have been deployed to Afghanistan and Iraq in support of operations. Many of them have been exposed to long-term combat-related stress or traumatic events. Ensuring the mental health of these soldiers and veterans is an important part … Read more

Hospitals and clinics staffed primarily by military personnel shall provide health care to serving soldiers and, where possible, their dependants, as well as to retirees and their dependants. When facilities are not available, health care for these civilians is provided by the Tricare program, formerly known as the Civilian Health and Medical Assistance Program (CHAMPUS). … Read more

Army Captain Jennifer Peace felt like she could finally breathe. Secretary of Defense Ashton Carter announced on television from Peace’s office that she could serve in public, as she had. It’s over, she realized. It was finally over. No more rules about men’s uniforms or cropped hair; no more subordinates awkwardly greeting him as “sir” … Read more

It is a sad and heartbreaking account of one soldier’s mission in Iraq (2005-2006) and his subsequent struggle to regain his footing and find meaning in the experience. In May 2005, Lt. Col. Bill Russell Edmonds, then a Special Forces captain, volunteered to serve in a provisional organization, the Iraq Assistance Group, created by the … Read more

View on treatment outcomes The Army strives to provide the highest quality behavioral health care possible to ensure the psychological readiness of every Soldier. To support this effort, the Army asked RAND researchers to identify factors associated with changes in outcomes for soldiers receiving Army behavioral health care. The Army is monitoring military behavioral health … Read more

A case study of military surgical technicians How to harmonize medical training for all types of weapons? Currently, the Air Force, Army and Navy maintain their own schools and train their own medical professionals differently. The 2005 recommendation of the Armed Forces Base Realignment and Closure Commission recommended the creation of a joint medical education … Read more

Views from the Health Providers In the United States, there are 5.5 million men and women who support a current or former member of the military with a disability or disabling condition. These individuals – we call them military caregivers – are often unpaid and often have other work and family responsibilities. They are our … Read more

Much has been written and discussed about the increase in post-traumatic stress disorder (PTSD), depression, alcohol abuse, sexual violence, suicide and other mental health problems among soldiers in Iraq and Afghanistan after 13 years of armed conflict. These problems are considered among the most serious in military healthcare, for which scientific solutions are needed. All … Read more

Results of the first year of the TRICARE Senior Prime demonstration grant The Department of Defense is committed to providing comprehensive health care to the men and women who serve our country. However, its health care system, one of the largest in the country, falls short of this goal for military retirees when they reach … Read more

Medical Leadership in the Military The military healthcare system faces several challenges: exploding healthcare costs, the increasing importance of performance management, combat operations that have placed unprecedented pressure on the healthcare system both at home and abroad, and the need to integrate medical forces into joint operations. Leadership has a key role to play in … Read more

In the United States, 5.5 million men and women care for a current or former soldier with a disability or illness. We call these people military caregivers. Of these, 4.4 million care for veterans who served before September 11, 2001 (pre-9/11 caregivers) and 1.1 million care for veterans who served after September 11, 2001 (post-9/11 … Read more

How the “Welcome Back Veterans” campaign makes a difference Welcome Back Veterans (WBV) is a unique program created in 2008 with funding from Major League Baseball Charities and the Robert R. McCormick Foundation. WBV has awarded grants to medical schools across the United States to implement programs that address the mental health needs of soldiers, … Read more

The U.S. Department of Defense (DoD) provides a range of support services to military personnel and their families. While some of these services are funded by congressional appropriations, many others are covered by non-appropriated funds. However, as current defense planning calls for both troop and budget reductions, DoD is seeking synergies to improve support services … Read more

The HRBS is the U.S. Department of Defense’s (DoD) flagship study of the health, health-related behaviors and well-being of military personnel. The HRBS has been conducted regularly for more than 30 years and covers areas that may affect military readiness or the ability to meet the demands of military life. The Department of Defense Office … Read more

Constant deployments have strained military personnel and families, who are already burdened by frequent moves and parental absences. These stressors include children’s social or behavioral problems at home and at school. By better understanding the issues children face when parents or guardians are deployed, the Army can more effectively target services to military families and … Read more

Non-FDA-Approved Drugs in Military Combats The 1991 Gulf War raised many ethical and political questions about the use of research medicines to combat chemical and biological warfare: what is the difference between “research” and “treatment”? Can informed consent be waived? If yes, under what conditions and who is entitled to grant a waiver? Richard Rettig … Read more

There are about 5.5 million American People caring for ill or wounded veterans and military members More than 2.5 million U.S. military personnel have been deployed to Afghanistan and Iraq since 2001. Their wartime experiences have led to a sharp increase in the number of veterans with disabilities. Many veterans of these and previous conflicts … Read more

The HRBS is the U.S. Department of Defense’s (DoD) flagship study of the health, health-related behaviors and well-being of military personnel. The HRBS has been conducted regularly for more than 30 years and covers areas that may affect military readiness or the ability to meet the demands of military life. The Department of Defense Office … Read more

Two weeks ago, we released the most comprehensive survey to date of caregivers of U.S. military members. An estimated 5.5 million family members, friends and acquaintances provide a range of services to current and former military members with physical or mental disabilities or illnesses, saving the country billions of dollars each year. However, caregiving can … Read more

Improving access to behavioral health care for migrants and their families Perhaps more than ever, military personnel and their families need access to mental health services. But research shows that the longer people have to travel for care, the less likely they are to seek it. How many service members and their families are denied … Read more

Policies, programs, obstacles to implementation and recommendations for the future Sleep problems are a major complaint of military personnel returning from deployment. Sleep disorders, such as insufficient sleep time, poor sleep quality, nightmares, and daytime sleepiness, may be caused by physical (e.g., pain, brain injury), behavioral (use of stimulants or electronic devices before bedtime), or … Read more

The Commission on Base Realignment and Closure recommended the creation of a joint medical training and education center to promote the exchange of medical personnel and units, interoperability among the different services, and cost and efficiency gains. In accordance with this recommendation, such a campus has been established at Fort Sam Houston, Texas. RAND Health … Read more

News from the recent RAND Deployment Life Study What happens to military families when a soldier deploys? Studies have shown that military deployments are associated with poorer mental health, behavioral problems in children, a higher risk of divorce, and a higher incidence of suicide in military families. Not surprisingly, military members and their spouses consistently … Read more

Analizing & Influencing The Veterans Health Administration is an organization within the Department of Veterans Affairs (VA) that provides health care services to veterans. In 1997, the Veterans Health Administration established the Veterans’ Equitable Allocation of Resources (VERA) System to improve the distribution of congressionally appropriated medical resources among the 21 Veterans Integrated Service Regional … Read more

They are wives, husbands, mothers and fathers, good neighbors who check in, best friends who help. They sacrifice their time, their work and even their health to provide a multi-billion dollar service to America, often without any recognition. These are caregivers of active and retired military: not paid professionals, but loved ones struggling with panic … Read more

Weekly Roundup – Grants to Russia, no-fly zones, telemedicine: the RAND Weekly Roundup We discuss how the West can help the Russians get accurate information about the war in Ukraine; why it would be a strategic mistake to discard a no-fly zone policy; assessing pain management in the military health system; questions about the quality … Read more

The U.S. Department of Defense (DoD) and Veterans Affairs (VA) health systems are responsible for providing health care to more than 9 million beneficiaries, with some overlap in their populations. Both systems provide services through a combination of direct care, delivered in government-owned and operated facilities, and purchased care, delivered by the private sector, primarily … Read more

How can the system be reorganised? Since the end of the Second World War, there has been repeated discussion of the need to create a unified military health system. Some observers have argued that a unified organisation could lead to cost savings, better integration of healthcare services, more efficient administrative processes and better training. A … Read more

The U.S. Department of Defense (DoD) offers short-term, confidential, solution-focused counseling services for personal and family problems that do not require treatment in the military health care system. These services, referred to as non-medical counseling in the military, address a wide range of issues, including stress management, relationship stress, grief, separation, and adjustment to deployment. … Read more

The Health Behavior and Behavior Survey (HRBS) is the US Department of Defense’s (DoD) primary survey of the health, health behaviors and well-being of military personnel. The HRBS, which has been conducted regularly for more than 30 years, covers areas that may affect military readiness or the ability to meet the demands of military life. … Read more

The Health-Related Behavior Survey (HRBS) is the US Department of Defense’s (DoD) primary survey of the health, health behaviors and well-being of military personnel. The HRBS, which has been conducted regularly for more than 30 years, covers areas that may affect military readiness or the ability to meet the demands of military life. The Department … Read more

Debra Mendelsohn feels the nightly terror of a loved one in danger, the heartbreaking frustration of being a single mother of two, and the strain of a bad Skype connection. Her family is a military family that has stuck together through three deployments that could have tested them, but did not. He came to rely … Read more

Understand and optimize the System Behavioral health technicians (BHTs) are military personnel who are expected to provide clinical support services alongside independent, licensed behavioral health providers. When optimally integrated, BHTs can enhance the mental health capacity of military personnel and ensure that military members have access to high-quality, effective services. BHTs are trained to conduct … Read more

Last week, the Associated Press released data showing that there were more suicides in the military this spring than ever before. If this trend continues, 2012 could set a record for military suicides. RAND and the Department of Defense, along with other organizations, have been working to prevent suicides for years, so this news was … Read more