Summary

Based on studies showing that many military members are performing tasks that are not considered military essential, the Air Force, Army, and Navy have plans to convert certain numbers of military health care positions to civilian positions. Questions have surfaced regarding the potential effects of these conversions on the Defense Health Program. The National Defense Authorization Act for Fiscal Year 2006 prohibits the military departments from performing any further conversions until the secretary of each department certifies to Congress that the conversions will not increase costs or decrease quality or access to care. The act also requires GAO to study the military departments' conversions and their potential effects. Specifically, GAO examined (1) the military departments' plans for and actions to date in converting military health care positions to civilian positions and the departments' experiences in filling the converted positions with civilians and (2) the potential effects of converting military health care positions to civilian positions on the Defense Health Program.

The Air Force, Army, and Navy have converted or have plans to convert several thousand military health care positions to civilian positions and have made progress in hiring civilian replacement personnel. From fiscal years 2005 through 2007, the Air Force, Army, and Navy collectively have converted or plan to convert a total of 5,507 military health care positions to civilian positions. Of the 5,507 military health care positions, the departments plan to convert 152 physician positions, 349 nurse positions, and 208 dental positions to civilian positions. In fiscal year 2006, there were a total of 10,352 military physicians, 9,138 nurses, and 3,020 dentists in the Air Force, Army, and Navy. The Navy is the most significantly affected of the three military departments, having converted or planning to convert a total of 2,676 military health care positions, representing 49 percent of the total 5,507 positions converted or planned for conversion. While the departments have been recruiting for about 4 to 7 months to hire civilian replacements for converted positions, to date, they have not experienced significant difficulties filling the civilian positions. The military departments do not expect the conversions to affect medical readiness, quality of care, recruitment and retention of military health care personnel, or decrease beneficiaries' access to care. However, it is unknown whether the conversions will increase or decrease costs to DOD. At present, the military departments may not prepare their congressional certifications using cost data prepared by DOD's Office of Program Analysis and Evaluation, which is identifying the full costs for military health care positions. Instead, the military departments may use cost data that do not contain all the costs, like training, necessary to support a military medical position. Without accounting for the full costs in their methodologies, the military departments will not be able to make a true comparison of the total costs required to support military positions versus civilian positions. Moreover, Congress will be unable to judge the extent to which the departments' certifications are based on actual and anticipated compensation costs for civilian hires unless they include such delineations in their certifications.

Recommendations

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Recommendations for Executive Action