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has been dulled. People are overworked. They feel they are not seen as valuable members of this country's defense team. Others are underutilized and frustrated because of nursing and technician shortages.

Basically, we have entered a period of drought in military budgets. The currency of this drought will be end strength. I do not expect the Chief of Naval Operations or the Secretary of the Navy or the Commandant of the Marine Corps to spend their limited end strength on resources that do not directly contribute to delivering ordnance on target. And frankly, I would do the same.

We have several alternatives: First, contracting; civilian hires; managed care arrangements; and CHAMPUS. And all of those initiatives we have taken, and all of those preserve end strength.

Unfortunately, continuing reliance on these alternatives has the potential of seriously deteriorating the readiness of our medical department. In fact, we are now at less than critical mass. If something is not done very soon, the deterioration will accelerate as residency review programs withdraw their program accreditations.

The result will be a cooldown of the medical department, leaving us barely capable of conducting full service sick call on active duty persons.

Now, I would submit there is a way out and that there are five steps that I see to success: First, provide additional medical department end strength;

Second, decouple medical end strength from line end strength; Third, release CHAMPUS dollars for use in contracting;

Fourth, provide the authority to transfer money from O&MN to MPN accounts in order to make the changes in officer compensation so that we can be more competitive with our private sector;

And fifth, I would ask for DOPMA relief, not just for the medical corps and dental corps, but all of the medical department officers, in such areas as officer-enlisted ratios, rank structure, and accession and retention age changes.

Now, combine those five measures with a tincture of time and your continued positive support and I think we can reverse the trend.

I thank you for taking the time to discuss Military Medicine.
The prepared statement of Admiral Zimble follows:






Good morning Mr. Chairman and members of the committee.

I am Vice Admiral James Zimble, Medical Corps, United States Navy,

Director, Naval Medicine and Surgeon General of the Navy.


you for the opportunity to appear before you today to discuss Navy


This Posture Statement will describe the state of Navy

healthcare and highlight some of the more pressing issues with

which we need your help.

We have, over the past several years,

made very good progress toward eliminating our shortfalls in

deployable medical units.

Also, the quality of care provided in

our facilities is continually demonstrated to be competitive with,

and in some cases superior to, the finest care available in the

private sector.

Navy people still tell us that they prefer to

receive their healthcare in Navy facilities, from Navy people. I

must tell you, however, that all of these things are seriously

threatened by the current state of the Navy healthcare system. The

crux of the problem is a chronic and severe shortage of healthcare personnel. This problem cannot be overstated. As a result, most

of the initiatives you will hear about today are directed toward

attracting good people and retaining those who are now serving so

well, under less than the best conditions.

Overview of Navy Medicine

The Navy healthcare system exists to provide prompt and

effective medical care to combat forces in time of conflict and to


maintain the health status of active duty members in peacetime.

Successfully accomplishing this mission contributes directly to the Navy's ability to sustain combat operations.

During peacetime we provide healthcare services to authorized

beneficiaries using resources that will be needed during war.

Dependents of active duty personnel, retirees and their dependents are provided healthcare services to the extent resources will permit; of course, our active duty personnel must receive first

priority for medical services.

Our direct care system consists of hospitals and clinics

managed through Medical Commands.

The Naval Medical Command is

responsible for the operation of 31 hospitals in the United States and overseas (four of which are comprehensive teaching hospitals and another four are family practice teaching hospitals), 188 medical clinics, and 176 dental treatment facilities. These are exclusive of facilities on U. S. Navy Ships or in Marine Corps

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Naval Medical Research Institute, Naval Health Research Unit, Naval Dental Research Laboratory, the Naval Medical Research Units, the Naval Biodynamics Medical Laboratory, the Naval Submarine Medical Research Laboratory, and the Naval Aerospace Medical Research


Also under the aegis of the Naval Medical Command are the Naval Aerospace Medical Institute, the Navy Ophthalmic Support and Training Activity, the Naval Medical Data Services Center, the Naval Medical Materiel Support Command, the Navy Environmental

Health Center, and the Naval Health Sciences Education and Training


The Navy Environmental Health Center is the Navy's

equivalent of the Centers for Disease Control. It is responsible for tracking infectious disease, for preventive medicine measures, and for environmental and occupational health.

The Naval Health Sciences Education and Training Command

(HSETC) operates the Naval School of Health Sciences and Hospital

Corps schools.

HSETC trains medical personnel and oversees

outservice and inservice training programs.

A large part of our peacetime healthcare program is direct

Fleet and Fleet Marine Force support. Many of our personnel are

deployed today to afloat units.

There are over 320 physicians, 195

dentists, 4,600 hospital corpsmen, and 508 dental technicians

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assigned to Navy afloat units. Additionally over 200 physicians

and about 2800 hospital corpsmen are assigned with deploying

units of the Marine Corps. Supporting these nissions is not

without cost.

For example, we estimate the total annual CHAMPUS

bill resulting from hospital medical personnel being deployed to support Persian Gulf operations exceeds $2.6 million; a large part of which comes directly from Navy Department beneficiaries as


Medical manpower resources not deployed in direct support of fleet operations or engaged in maintaining the health status of the active force are available to provide services to non-active duty


There continues, however, to be a large residual

demand for health services beyond what can be provided in the direct care system, forcing beneficiaries into the only alternative

available, the CHAMPUS program. Several recent initiatives will help to alleviate some of the pressures placed upon our hospitals

and clinics.

For Navy, the most important of these to date has

been the development of the NAVCARE clinics. Learning from our

colleagues in the Army Medical Department and their very positive

experiences with PRIMUS clinics, the Navy has opened four NAVCARE

clinics in the past fiscal year.

These clinics are very popular

with our patients who are using the clinics at a rate which is up

about 30% over the FY 87 levels.

The average cost of an outpatient

visit through CHAMPUS is about $65, while the average cost per

visit in a NAVCARE clinic during fiscal year 1987 was about $46;

nearly a 30% discount on the cost of a CHAMPUS visit.


clinics are important extensions and integral parts of our direct

care system. They provide a base for referrals into our


We intend to improve on that referral base.

We are

planning to open 6 more clinics this year. The clinics we will open this year are designed to also care for patients with chronic health problems such as hypertension or respiratory dysfunctions. Further, the clinics opened in 1987 will be modified to include

chronic care. The principal benefit to our patients is that they will have much improved access to the system. Obviously, the Navy also benefits from these clinics. The patients treated in these clinics and subsequently referred to our hospitals for inpatient care are important to provide a diverse patient population. They enable our specialists to provide care to a challenging group of patients of all ages and states of health. These patients are also of critical importance to our graduate medical education programs. In addition to our NAVCARE clinics, we are also aggressively pursuing contracting for selected services. This important

initiative will help us recapture CHAMPUS workload, take the edge

off the access problems in some of our facilities, improve the use

of our capital investment in facilities, and bring people back into

our facilities at a cost that will save both the government and the

beneficiary money when compared to using CHAMPUS. We have awarded contracts for services in the specialties of radiology, general

surgery, pediatrics, OB-Gyn, psychiatry and internal medicine in

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