U.S. Studying Changes in GIs’ Medical Care : Weinberger Discusses Possible Services Shift for Retirees, Families

Defense Secretary Caspar W. Weinberger, criticizing the military’s ability to provide medical care to GIs during wartime, raised the possibility Monday that the Pentagon would shift medical services for military retirees and dependents from its own hospitals and clinics to other medical centers.

Weinberger’s remarks on the politically sensitive issue were included in his first lengthy public comments on the state of military medical care in the wake of what he said were problems feeding “the misperception by some that ours is a second-rate system.”

“We do have problems to be solved,” Weinberger acknowledged in disclosing that the Pentagon is examining all its health care facilities.

Shift in Operations

Speaking to a Defense Department health conference in suburban Springfield, Va., the defense secretary said the Pentagon was concerned that the medical corps had shifted from a force capable of meeting its primary mission--saving the lives of troops wounded in battle--to one directed at providing “family-oriented medical care.”

The recent focus on the quality of military doctors and hospitals follows several highly publicized incidents of malpractice and questions about the standards of the military services in accepting civilian doctors’ credentials.

In one case, a former surgeon at the Bethesda Naval Medical Center near Washington, Cmdr. Donal M. Billig, is facing a court-martial after the deaths of four patients. Three naval officials have been issued administrative letters of censure--a severe criticism--in connection with his hiring.

Weinberger made no reference to the Billig case or to any other specific incidents. But, after praising the quality of medical students seeking careers in the military, he said: “In the future, this department will give even greater emphasis to quality assurance measures.”

The defense secretary raised the issue of medical care for military family members and retirees by saying that three-fourths of the military’s medical workload is devoted to “other than active-duty patients.”

The extensive medical care offered to military families as well as retirees is considered one of the standard benefits of military life, easing the financial burden of lower-paid troops and assuring soldiers that family members will be able to receive adequate care while the GIs are away from home.

The Pentagon has estimated that its medical program cares for 10 million persons, of whom 2.1 million are on active duty.

Weinberger said that in the interest of greater efficiency, he is asking Dr. William Mayer, the assistant secretary of defense for health affairs, “aggressively to seek arrangements with community medical resources.”

Discusses Options

He held out several possibilities for providing such care, among them enrollment of personnel not on active duty in health maintenance organizations or the use of community outpatient care centers. And he acknowledged that the U.S. government had a “statutory and a moral obligation” to meet these medical needs.

But, he noted:

“I do not believe that we can afford such luxuries as fully staffing a military obstetrics unit for 10 deliveries a month, or maintaining expensive training programs for medical specialties that are of little or no use in war. Similarly, we will not spend public resources on the construction of expensive hospitals, clinics and medical centers when quality services are available elsewhere in the community, and when there is no ‘readiness’ reason for doing so.”