Military Health Care Administration: Balancing Costs and Ethics

Introduction: Why I Chose Health Care Administration

As a health care manager, the reasons for choosing this profession and the day-to-day activities that fill my schedule are often very different. As a health care professional, I entered this field to make a contribution to the health and well-being of my fellow soldiers. I chose to become part of the support system that keeps the military functioning and enables service members to freely commit themselves to the defense of our country. As a health care manager, however, my time is filled with responsibilities revolving around categories that have little to do with the daily care of the soldiers and civilians who use our facilities. My job responsibilities focus on the administrative, financial, legal, and ethical aspects of keeping medical care facilities operational, so that other health care staff — such as doctors and nurses — can tend to the medical well-being of patients.

Administrative Challenges in a Multicultural Military Environment

Administratively, I am responsible for keeping a diverse staff functioning as a team. A multicultural mindset has taken hold in most professional environments, including the armed services. This has created a diverse set of attitudes and talents within the team operating in our medical facilities. While the military chain of command remains strong, as a health care administrator I am continually challenged to creatively assist my staff in working together effectively. We see changes in the demographics of both staff and those we serve, as well as changes in technology that create increased demand on our resources.

The multicultural mindset may be a positive framework for helping staff accept differences among themselves, but the increased number of those differences demands more management and problem-solving time. These changes are occurring simultaneously with shifts in financing and care management that create significant system instability (Kirkman-Liff, 2002).

Financial Pressures in Military Health Care

Driving the financial changes in the health care delivery system are rising costs in both the public and private sectors. Military health care systems cannot remain unaffected by these rising costs because we are interrelated with the broader health care economy. We purchase medicines from the same sources and acquire the same diagnostic machinery. While military wages are not as volatile as those in the civilian world, the cost of health care is rising due to these and other interconnected factors.

In order for health care facilities to remain operational, I am responsible for balancing needed care options against the most economical methods of delivering those services. In the civilian world, nearly one-third of health care expenditures are spent on hospital care. When patients, employers, insurers, and the government worry about rising costs, they put pressure on hospitals to provide more efficient care — and that pressure lands on the shoulders of the health care administrator (Shah, Reed, Francis, Ridley, and Schulman, 2003).

Conclusion: Balancing Readiness, Care, and Responsibility

Keeping a military unit operational at the highest level of readiness is a combined effort that requires dedication from many disciplines. Medical services are one of those areas that must serve the needs of individual patients as well as the overall military mission. We must balance the needs of today with those of tomorrow within a constantly changing world.