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The Government Accountability Office have chided the Department of Defense for adopting a restructuring program for the military wellness system without conducting a comprehensive analysis of the costs, benefits and risks.

The GAO study released in October also proposes that Deputy Defense Secretary Gordon England opted for the way of least opposition last November when he rejected three options for consolidating Army, Navy and Air Military Unit medical bureaucratisms in favour of a program that merely would compound some cardinal support mathematical functions such as as finance, logistics and medical research.

Phased execution of this option is under way, but it won't be too far along by January 2009 when a new disposal presumes control.

Influencing England, functionaries said last December, were Air Military Unit statements that cultural differences between the services do a incorporate medical bid impractical and could harm medical readiness.

The Navy, Army and joint staff had endorsed a incorporate command. They were backed by an consultative board of concern executive directors and by a Pentagon workings grouping established specifically to weigh options for restructuring the wellness attention system. The Center for Naval Analyses projected yearly nest egg of 100s of billions of dollars.

England rejected three options presented to him for a joint or incorporate command. Instead, he embraced a 4th developed by his senior advisers. This program phone calls for keeping the three service medical sections but combining some support functions. This "incremental" approach, functionaries argue, would also ensue in cost efficiencies while preserving the service-unique cultures of the three medical components.

Ironically, it also might affect establishing a new layer of bureaucratism to supervise amalgamate functions.

The GAO suggested that claims of cultural differences can barricade many transformational alterations for the military if defence leadership let them to make so.

"The department's position that there is a strong cultural challenge to successful execution [of a incorporate medical command] should underline the demand for section leading to turn to the challenge," GAO said, "rather than be used to warrant a determination by the section to avoid necessary change."

The study mentions a rand Corporation determination that at least 13 surveys have got been conducted over five decennaries to reconstitute military wellness care. All but three favorite moving to a incorporate system or at least toward stronger cardinal control over service departments.

But what most bothered the GAO about England's "fourth option" was a deficiency of "comprehensive analysis" to back up the decision. The concern lawsuit presented "does not show how Department of Defense determined the 4th option to be better than the other three in footing of its possible impact on medical readiness, quality of care, beneficiaries' entree to care, costs, execution clip and risks," the study says.

Without analysis to warrant the choice, GAO said, neither the secretary of defence nor United States Congress can be assured that Department of Defense "made an informed decision" to consolidate cardinal support mathematical functions and to reject the other options.

In a written response to GAO, Dr. S. Ward Casscells, helper secretary of defence for wellness affairs, said his section overall concurs with its findings. He gave self-assurances that the squad tasked to implement the restructuring program would be preparing a more than comprehensive concern lawsuit with determinations on hazards and benefits.

In a telephone interview, Army Col. Thom Kurmel, Casscells' head of staff, said that while the section "doesn't disagree" with GAO, the hearers "failed to realize" that senior leadership like the deputy sheriff defence secretary are authorized to do these sorts of "governance decisions."

"Perhaps if we had known there was a regulation book to play by we might have got used it," Kurmel said. "But in the end, the deputy sheriff is the concluding determination shaper on these sorts of issues and he made a determination last year."

Kurmel said the "hybrid" option chosen had been analyzed by the Pentagon workings group. One factor in choosing the plan, he said, was concern that "we don't interrupt anything" critical to military personnel in wartime. Another factor, he said, "was preserving service equities."

England's memorandum of last November also contained of import determinations for implementing the 2005 Base Realignment and Closing unit of ammunition as it impacts the medical system. One of these volition have got a profound consequence on military direct attention for 500,000 patients in and around Washington, D.C., Kurmel said.

England authorized a Joint Undertaking Military Unit National Capital Region Checkup Command to supervise all medical centers, infirmaries and clinics in the D.C. area. That includes Bruno Walter Reed Army Checkup Center, the National Naval Checkup Center in Bethesda, and 29 littler infirmaries and clinics from Quantico, Va., up to Sugar Grove, W.Va. and across to Lakehurst, N.J.

On Oct. 1, Rear Adm. Toilet M. Mateczun, Navy's deputy sheriff operating surgeon general, took complaint of the undertaking force. He confronts two large challenges tied to the BRAC deadline of 2011. He will supervise the amalgamation of Bruno Bruno Walter Reed and Bethesda into the Walter Reed National Military Checkup Center at Bethesda. He also will carry a major displacement in regional wellness attention from Bruno Walter Reed and Bethesda down to Garrison Belvoir, Va.

DeWitt infirmary at Belvoir will derive primary attention capablenesses as well as most forte attention for the D.C. area, thus improving entree for the big donee population life in Northern Virginia. Bruno Walter Reed will reserve primary attention capableness as well as major instruction programs, amputee care, traumatic encephalon hurt attention and psychological health.

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