Restructuring military health care: the winds of change blow stronger.

The Military Health Services System is an enormously complex enterprise, consisting of more than 400,000 personnel in the active, reserve, and civilian workforce, operating 148 hospitals and over 800 medical and dental clinics worldwide, and serving nearly 9 million beneficiaries. Expenditures on military health care activities will exceed $15 billion in 1993. Yet many people in leadership positions in government--both inside and outside the Department of Defense--question whether the current organization of the Military Health Services System is appropriate to accomplish the Department's medical missions. Some insiders have observed that having three military medical services is having two too many--that a single "purple" medical service, or at least a single management structure such as a Defense Health Agency, would better meet military mission requirements as the Defense Department undergoes post-Cold War downsizing. One of the most pressing challenges facing military health care managers is how to best organize resources to provide timely access to quality care and achieve economies at a time when civilian health care is itself in turmoil. This article provides a long-awaited update on the spirited debate over the need to reorganize the Military Health Services System--and the prescriptions ordered so far to cure the system's perceived organizational ills.

Innovative approaches in governance: a case study of the Greater Southeast Healthcare System.

Washington, D.C.'s Greater Southeast Healthcare System is like a spinning top--balanced by internal energy and driven by external forces. Those forces, the voices of the system's community, have provided Greater Southeast with direction and governance that have brought the system national recognition as well as an agenda for change. Even more important, they have resulted in services that have grown deep roots in the community.