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short of success because of funding constraints.

I am working with the Air

Staff to identify the additional resources we require to adequately maintain

safe, efficient and adequate medical treatment facilities.

Quality Assurance

All quantifiable measures show the Air Force Medical Service continues to

offer high quality medical care.

For example, and most significantly, this past

year we had ava i lable the first results of the External Civilian Peer Review

Program.

This program, developed by the Assistant Secretary of Defense for

Health Affairs two years ago, has civilian medical professionals review the

record abstracts of patients treated by military medical facilities to evaluate

the quality of care being provided.

This is an unprecedented undertaking.

Nothing comparable has been accomplished in civilian medicine.

Since January

1986, approximately 33,000 Air Force records have been reviewed.

in that time,

only 31 cases were identified by the civilian peer review panel as cases in

which potentially unacceptable care was provided.

This is a remarkable result.

We believe this demonstrates that the Air Force, is providing excellent care.

This past fiscal year, the number of malpractice claims filed against the

Air Force held steady from the previous year.

Three hundred, forty-eight claims

were filed, an increase of ten from the previous year, but well below the 378

claims filed in 1985.

The malpractice rate in civilian medicine continues to

escalate.

During the year, we treated over 17 million outpatients, over a

quarter of a million inpatients, and delivered over 37,000 babies.

Finally, we have worked very closely with the Department of Defense in

preparing to support the Health Care Quality Improvement Act of 1986 as it will

apply to the military.

Once the national professional disciplinary data base

mandated by this law is established, we will immediately be able to provide the

appropriate reports.

Incentive Special Pay

The recent legislative change to Incentive Special Pay (ISP) that removed

the 6% budget limitation and the $8,000 payment ceiling for critically needed

wartime specialties was an important first step in reducing the pay gap between

military and civilian incomes.

The average difference between military and

civilian incomes in the specialties that receive ISP is significant.

The

September 1987 issue of Medical Economics reported a 1986 net civilian practice earnings of $146,430 for "all surgical specialists," compared with an average

lieutenant colonel physician's compensation of $82,000, which includes $8,000

ISP; a difference of $64,000.

Although we can reduce this wide dispar ity by

paying more money in ISP beginning in FY 89 to the most critical specialties, we

are reluctant to risk damaging the morale of the Medical Corps as a whole by

extraordinary expansion of the differentiation between the 20% ISP "haves" and

the 80% ISP "have nots."

A much better solution is to increase all categories of special pay

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variable special pay, additional special pay and board certified pay.

The rates

for these pays have not increased since they were set in 1980.

Long over due

increases are necessary to reduce the income gap for all physicians, not just

those in wartime specialties.

I will request that Dr.

Mayer

include these

increases in the Biennial Report of Special Pays, which is due to Congress at

the end of September.

Officer Reduction and Staffing

I greatly appreciate the Congressional direction to exempt the Medical

Service from the officer reduction of 1% in FY 88.

This has enabled us to

increase wartime readiness, better meet the health care requirements of our

beneficiaries and minimize costs.

I want to re-emphasize my concern about

possible future cuts that could result in either a reduced level of services or

an increased CHAMPUS cost.

congressional support of manpower growth in the Five Year Defense Plan will

allow the Air Force to meet most of its contingency requirements.

Our military

manpower is programmed to grow over three percent between now and 1992.

The

growth is paced to coincide with the delivery of our deployable assemblages.

We

are using the additional manpower effectively in peacet ime to expand services

available to our beneficiaries.

Overall, we are able to staff currently author ized positions.

Although,

.

same problems exist in the mix of providers on active duty, efforts in

increasing critical medical specialists (i.e., general surgeons) have been

successful.

We cont inue to have shortfalls in radiology, psychiatry, OB/GYN and

nurse anesthesia, and I am very concerned about the vastly increased competition

for nurses.

Armed Forces Health Professions Scholarship Program

This past year, legislation was enacted affecting the Armed Forces Health

Professions Scholarship Program.

This program is our main source of high

quality physician accessions.

Effective 1 October 1989, the DOD must have 2,500

participants designated who are in the final two years of their course of study;

and, who have agreed to accept, if offered, residency training in a critically

needed wartime skill.

We understand the intent of this legislation was to

target a sizeable portion of the program participants to meet wartime

requirements.

A recent Association of American Medical Colleges survey of

medical students reported only 23% have decided on their residency preference by

the time they enter their third year of medical school.

Furthermore, how can we

ask a medical student to agree to residency training in a designated specialty

when the student cannot guarantee the Air Force he will be selected?

It is a

highly competitive process, with medical students not chosen until the end of

their fourth and final year.

For those selected, there of course is no

guarantee that they will complete training.

Additionally, even if feasible, we

are not certain this would be attractive to a potential applicant who has

obtained alternative financing for the first three years of medical school.

Will that individual commit to military service for only one year of scholarship

benefit?

Medical Readiness

Medical readiness is our first priority.

We are committed to the

deterrence of war through operational support to our fighting forces.

Optimum care system.

effectiveness.

To prepare for the treatment of the injured and sick during

wartime, we operate a comprehensive health care system in peacet ime which

ensures that our medical response for wartime is rapid and ready.

We are

committed to supporting the flying mission through a community based health care

system within the Air Force operational command structure.

We are convinced

that the wellness of our airmen and his or her family is a key ingredient to the

Air Force's mission capability and overall readiness posture.

We have made remarkable progress since the late 1970's.

We adopted the

four echelons of medical care system.

This system provides for an increased

level of medical capability as patients are evacuated from the front lines and

establishes a level of care at each echelon that focuses on two basic

objectives.

First, and foremost, mission Isupport is maximized if we are able

to treat and return to duty as many airmen as possible.

Seocnd, for those

unable to return to duty, their condition must be stabilized and properly

managed until they can be evacuated to where more definitive care is available.

our investment in war reserve materiel has grown significantly from $17

million in 1978 to $450 million this year.

Much of this investment has been

prepositioned over seas at expected places of use.

Readiness training continues

to improve the capability of medical personnel to cope with the environment and

equipment limitation found in the combat scenario.

We have also reduced our

manpower shortfall necessary for wart ime requirements.

We have been able to

sustain growth in the active component and have realized significant growth in

the reserve component.

Our strength in readiness bolsters the peacet Ime health

Much of our wartime readiness is enhanced during peacetime through

the practice of medical and dental care in our Air Force hospitals.

Conclusion

in closing, I want to emphasize my personal commitment to quality health

care services and reducing CHAMPUS costs.

Given adequate resources, including

money and manpower, we can do the job well.

with further cuts in our program,

our ability to meet the health care needs of our beneficiary population is

uncertain. To do our best, will take strong leadership and greater local

management of resources.

with your support we can continue to meet the health

needs of our military families today and tomorrow.

Senator GLENN. Thank you.
Admiral Zimble.

STATEMENT OF VICE ADM. JAMES A. ZIMBLE, SURGEON

GENERAL OF THE NAVY Admiral ZIMBLE. First, Mr. Chairman and Senator Wilson, I want to thank you very much for the opportunity to be here. And again, I will make my remarks very brief and submit the statement for the record.

To Senator Wilson, I want to thank you. I am very gratified to see that you have essentially made all of my opening remarks, and I cannot do anything but support everything that you have mentioned earlier regarding readiness and support for our active duty dependents and for the retired.

I just want to add one fine point, and that is that the readiness for going to war, the peacetime care for active duty sailors and marines and their dependents and the retireds and their dependents are all inextricably related. We cannot do one job without the other.

We need the challenges that are provided through medical care of the retired and their dependents in order to stay professional and maintain our cognitive and manual skills to go to war.

Therefore, the space available basis for which they are treated bothers me, unless we make darn sure that we make space available for them. Having facilities which are undermanned and underutilized only serves to show where we have allowed good capital investments to languish and not challenged our providers.

When he gave his posture statement last week, Admiral Trost said Navy men and women are at sea, in ships and aircraft throughout the world, day in and day out, every day of the year. And I hasten to add, Navy medicine accompanies sailors and marines wherever they may be.

Navy men and women are our most valuable resources. And yet, I have to be the first to admit that the medical support for them and their families is eroding.

The Navy is doing its very best to protect medical in the face of some severe officer reductions. We mentioned this just briefly a moment before. This results basically in a double tax against the Navy line: the initial tax is the impact of the smaller base from which to take its cuts, since the medical department officers, fully 16 percent of the officer strength of the Navy lies within the denominator from which those percentage cuts are being taken.

In his posture statement, Admiral Trost said he would not field a hollow Navy. We are dangerously close to fielding a hollow medical department by default. The Navy has necessarily mortgaged the shore establishment and support functions, and medical has been included.

The problem is compounded by medical mortgaging of our smaller facilities in order to support our overseas facilities and our teaching hospitals. And now we are in the process of mortgaging our teaching hospitals.

Now, just as the physical condition of the shore establishment has deteriorated, the competitive edge of our medical department

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