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A Department of Defense plan to put the Army in charge of all military medical training and research could soon be pulled in favor of establishing a new Defense Health Agency to handle these responsibilities and more, senior officials have told the DOD Task Force on the Future of Military Health Care.

The Defense Health Agency, or DHA, would assume oversight of all medical training and research as well as management of Tricare and responsibility for some “shared” medical activities across the services.

The Tricare Management Activity would form the foundation of the new agency, with additional staff drawn from service medical departments. But the Army, Navy and Air Force would continue to run separate medical departments and retain control of their medical personnel and most facilities.

The DHA concept, seen as only an incremental step toward the dramatic streamlining and greater efficiencies projected from creating a unified medical command, has been endorsed by senior medical leaders. It awaits final approval of Deputy Defense Secretary Gordon England.

Dr. Stephen L. Jones, principal deputy secretary of defense for health affairs, said England still might decide to stick with an alternative “governance plan” for the military health system that he endorsed last year.

But that plan, which would give the Army responsibility for all medical training and research, has raised worries over “preserving service equities,” Dr. Michael P. Dinneen, director of strategy management for the military health system, told the task force members Wednesday at a hearing in Washington.

The DHA, Dinneen said, would be “a neutral party” for delivering “support functions … in an equitable manner across the three services.”

Unveiling of the Defense Health Agency concept surprised several task force members, in part because they had just listened to presentations by think tank economists on the merits, potential cost-savings and challenges for the department of creating a unified medical command.

“I hope I wasn’t asleep and missed it but I was expecting a briefing on the joint medical command,” retired Army Maj. Gen. Nancy Adams, former commander of Tripler Army Medical Center in Hawaii, told Jones. She asked him to explain why DOD officials had abandoned plans for a joint command.

The Army, Navy and Joint Staff had backed a unified medical command, saying it would make medical care more effective and save several hundred million dollars a year. The Air Force opposed the idea, citing clash of cultures that could weaken medical support of operational missions.

Jones ignored these disagreements in answering Adams.

“DOD leadership, when presented with the unified medical command, kind of saw that as moving all the way,” Jones told her. “And, of course, within the system, there are pros and cons for doing that.”

Hours before Jones unveiled the DHA concept, Sue Hosek, a Rand economist, summarized for task force members results of major study completed in 2001 on options for establishing a joint medical command.

Rand interviews then with military medical experts and leaders, she said, “found a lot of sentiment that, if you had to have something, a joint command was better than a defense agency.” The Defense Logistics Agency, she said, “was frequently mentioned, and not as a positive model.”

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