Inspector General Highlights Staffing Shortages in Military Health System

Dec. 7, 2023
Management advisory details concerns with access to healthcare services overseas and at smaller military treatment facilities

A Nov. 29 report from the Inspector General of the US Department of Defense highlighted concerns about access to care and staffing shortages in the Military Health System and made recommendations for ways to begin to address the issues.

After meeting with the four Service IGs, the DoD IG decided to publish a management advisory detailing ongoing concerns. The advisory consists of information provided by the Service IGs, Service Audit Agencies, and the Defense Health Agency (DHA) IG to the DoD Office of Inspector General (OIG), and includes findings from the DoD OIG based on its published work and received through hotline complaints. The DoD OIG did not independently verify the information provided by the Services.

The Military Health System (MHS) provides health care to 9.6 million beneficiaries,
including active duty service members and their families, military retirees and their
dependents, and in some instances DoD civilians and contractors. The MHS consists of a direct care system, where beneficiaries obtain care at military treatment facilities (MTFs), and a purchased care system, where beneficiaries obtain care from private sector providers administered by TRICARE network contracts.

The DoD OIG has identified issues with the ability of beneficiaries to receive access to
timely healthcare in prior published reports related to mental health and care provided during the COVID-19 pandemic.

During visits to the INDOPACOM Area of Responsibility in May and June 2023, the DoD IG was repeatedly informed by senior military and civilian officials of challenges with accessing healthcare, including challenges with access to mental healthcare.

The DoD OIG has received at least seven hotline complaints over the last year from MHS beneficiaries and MHS providers highlighting concerns with the ability to access care at MTFs, ability to access care in the TRICARE network, and staffing shortages at the MTFs.

The Service IGs also provided correspondence, documentation, and information
papers to the DoD OIG in April and May 2023 expressing concerns with the ability of
beneficiaries to access healthcare services across the MHS. The Service IGs specifically highlighted concerns with the ability of government civilian and contractor employees to access healthcare services overseas, and access to care at smaller MTFs, as well as staffing shortages. 

The Naval IG conducted focus groups in 2023 and consistently found medical care to be among the top reasons that service members are dissatisfied. The Naval IG provided focus group comments from Service members expressing dissatisfaction with their access to care and wait times for various health services, including routine primary care and mental healthcare. Further research by the Naval IG identified particular challenges with beneficiary access to care in locations that are either small, remote, or recently downsized from a hospital to a clinic. For example, the Navy identified access-to-care challenges in Pearl Harbor, Hawaii; Lemoore, California; Oak Harbor, Washington; and Pensacola, Florida, often due to a shortage of MTF and local network providers. According to the Naval IG, small MTFs often only serve active-duty service members and send all other beneficiaries, such as family members and retirees, to the TRICARE provider network.

However, the Service IGs provided data showing that some TRICARE networks are not
robust or adequate to meet this need and beneficiaries may have difficulty obtaining network care. For example, Naval Health Clinic Pearl Harbor in Hawaii provides limited specialty care and is currently only enrolling active duty Service members. Beneficiaries must use a network in Hawaii that only has one level 1 trauma center (compared to San Diego which has three) and exceeds the 28-day DoD access to care standards for some specialties, such as gastroenterology (49 days average wait time for an appointment), psychiatry (52 days average wait time for an appointment), and urology (67 days average wait time for an appointment).

Data provided by the Service IGs indicate that access to mental health services continues to be a particular problem. For example, at Naval Hospital Pensacola and surrounding clinics, the Naval IG provided data showing that many Substance Abuse Rehabilitation Program (SARP) counselor positions are currently empty, and Naval Hospital Pensacola has to consistently rotate these counselors across locations. 

The Air Force IG provided information from multiple MTFs describing mental health provider shortages and concerns about the ability of beneficiaries to access mental health care. For example, officials from Ellsworth Air Force Base Medical Clinic stated that access to care has been affected by a shortage of three civilian mental health providers. The officials said that without these

The DoD IG recommends that the Director of the Defense Health Agency identify all
specialties, by location, where the managed care support contractor provider network
is not meeting DoD access to care standards and, in coordination with the managed care support contractors, develop and implement a plan to bring those provider networks into compliance with the DoD access to care requirements.

It also recommends that the Director of the Defense Health Agency, in coordination with
the Service Surgeons General:
• Conduct a survey of TRICARE beneficiaries, civilians, and contractors
stationed overseas about their access to healthcare services.
• Conduct a survey of providers and clinic administrators at overseas
Military Treatment Facilities about access to health services at their location.

The DoD IG report said that “despite being provided an opportunity to respond to the report and an extension of the original due date, the Director of the Defense Health Agency did not respond to the recommendations in the report. Therefore, the recommendations are unresolved. We request that the Defense Health Agency Director provide comments within 30 days of issuance of the final report.”

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