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The collaborative research and service delivery partnership between the United States healthcare system and the U.S. Military Health System during the COVID-19 pandemic

Abstract

Objectives

To examine the military-civilian collaborative efforts which addressed the unprecedented challenges of the COVID-19 pandemic, particularly in areas including provision of supplies, patient and provider support, and development and dissemination of new vaccine and drug candidates.

Methods

We examined peer reviewed and grey literature from September 2020 to June 2021 to describe the relationship between the U.S. healthcare system and Military Health System (MHS). For analysis, we applied the World Health Organization framework for health systems, which consists of six building blocks.

Results

The strongest collaborative efforts occurred in areas of medicine and technology, human resources, and healthcare delivery, most notably in the MHS supplying providers, setting up treatment venues, and participating in development of vaccines and therapeutics. Highlighting that the MHS, with its centralized structure and ability to deploy assets rapidly, is an important contributor to the nation’s ability to provide a coordinated, large-scale response to health emergencies.

Conclusions

Continuing the relationship between the two health systems is vital to maintaining the nation’s capability to meet future health challenges.

Peer Review reports

Introduction

The U.S.COVID-19 pandemic has caused more than one million deaths in the United States (U.S.) as of June 2022 [1]. It was first declared a public health emergency (PHE) on January, 31, 2020 [2]. Since then, its rapid and continued spread has posed challenges in nearly all facets of the U.S. economy, most notably in the healthcare sector, which has struggled with bed capacity, provider availability, and supply chain issues to meet the needs of patients [3]. Provision of civilian health services is one of the largest industries in the U.S., composed of a fragmented delivery system organized at the local level and funded by a mix of private and federally funded insurance programs [4, 5]. While the U.S. civilian healthcare system boasts a multitude of strengths, including its large highly trained workforce, wide range of medical specialists, secondary and tertiary institutions, cutting edge medical equipment, and for some medical services, unparalleled health outcomes, it is frequently overburdened and cost-inefficient even during normal operations [6, 7]. The additional challenges posed by the COVID-19 PHE spurred collaborative efforts by the U.S. civilian healthcare sector with the U.S. Military Health System (MHS) in the national response to the COVID-19 pandemic [8, 9]. Such collaboration has traditionally occurred through healthcare training programs, or in times of natural or other disasters, though on a much smaller scale [10,11,12,13].

The MHS is a complex system that weaves together healthcare delivery, medical education, public health, private sector partnerships, and cutting edge medical research and development with personnel and infrastructure from the Military Departments (Army, Navy, and Air Force) and the office of the Assistant Secretary of Defense (e.g., the Defense Health Agency [DHA], and the Uniformed Services University of the Health Sciences.)[14] The MHS serves approximately 9.6 million beneficiaries, of whom approximately 17% are active-duty service members from every military branch, with the remainder being non-active-duty dependents and retirees, representative of the U.S. population [15]. The MHS is focused on deployment readiness with the ability to mobilize assets and resources efficiently in support of national public health emergencies. This paper explores the inter-relationship between the U.S. healthcare system and the MHS through the lens of a health systems approach. The World Health Organization’s (WHO) Health Systems Framework breaks down a health system into six building blocks: (1) governance, (2) medicine and technology, (3) human resources, (4) healthcare delivery, (5) finances, and (6) information [16]. A health systems approach enables a comprehensive and detailed review organized according to these building blocks, and illustrates lessons learned from the MHS support to the U.S. civilian health system during a time of global pandemic.

Methods

A review of the peer-reviewed and grey literature was conducted to examine the inter-relationship between the U.S. non-federal healthcare services and the MHS throughout the COVID-19 PHE. The six building blocks of a health system, as defined by the WHO, and shown in Table 1 below, were used to frame our findings and discussion [16].

Table 1 Description of WHO Building Blocks Used in this Analysis

Resources were identified through scanning the electronic search engines (Google, Twitter, PubMed) between September 2020 and June 2021 using terms specific to each health systems building block for the U.S. and MHS (see Additional file 1). Further, snowball sampling was employed during the literature review process within each building block to identify additional resources for review and inclusion. Studies were organized and described within the building blocks of health systems with an eye at drawing conclusions around the inter-relationship of the MHS and U.S. health systems.

Results

Governance

In comparison to the centralized governance approach guided by the National Security Strategy, the U.S. health services system is highly fragmented with many organizations involved in its governance, including Congress, the Department of Health & Human Services (DHHS), state and local public health departments, and the private sector healthcare insurers and systems [4, 5]. Governance of each body sculpted their response to the COVID-19 PHE, with the U.S. civilian healthcare system response largely shaped at the state or local level for initial decisions on lock down/stay at home directives, access to testing, and mask-wearing guidelines and messaging [17, 18]. In contrast, the more centralized nature of the MHS led to more consistent messaging, including the rollout of standardized language and guidelines around Force Health Protection Conditions, using the provider-based Clinical Communities Advisory Council as a bi-weekly sounding board [19]. Additionally, the development of MHS clinical practice guidelines for the treatment of COVID-19 was built on the existing platforms for the Joint Trauma System, enabling rapid development and dissemination of guidelines on a system-wide level [20].

The MHS provided coordinated support on request to state and local-level civilian authorities through the joint doctrine Defense Support To Civil Authorities (DSCA) [21]. As a result, the MHS retained its centralized communications but generally followed state-level guidance.

Medicine and technology

Medicine and technology have been vital aspects of the nation’s response to the COVID-19 public health emergency, most notably in Operation Warp Speed (OWS), a $10 billion initiative which aimed to forge “a partnership between DHHS, the Department of Defense (DoD), and the private sector focused on developing, producing, and distributing materials for testing, prevention, and therapy on a rapid timeline.”[8] Specifically, the role of the DoD as a co-lead was to provide leadership through logistical expertise, including program management and contracting proficiency [22]. The DoD also contributed to research efforts alongside manufacturers from the U.S. healthcare sector, including clinical trial testing at MHS operated military treatment facilities [23]. Notably, the U.S. Army Research Institute for Infectious Diseases, in conjunction with pharmaceutical manufacturer Gilead, performed necessary testing for Gilead’s existing drug Remdesivir to receive Food and Drug Administration approval as a potential treatment for COVID-19 [24, 25]. As of June 2021, three vaccines had been awarded emergency use authorizations, and were distributed to adults and children over 12 across the U.S [26]. As of June 2021, OWS contributed to the distribution of over 372 million vaccines nationwide, including 4 million vaccines to DoD personnel [27, 28]. Aside from OWS, the military has also engaged in research of its own showing how medical practices in the military can inform civilian public health practices, a specific example being the use of military experience with different testing strategies and ways to mitigate the spread of the virus in close quarters and applying such experience to civilian college dormitories, prisons, and sports training environments [29].

Human resources

The U.S. has a highly skilled workforce, but staff shortages exist and are expected to grow in the coming years [30, 31]. The COVID-19 pandemic exacerbated this staffing shortage due to increased volume of patients and illness among providers [32, 33]. Critical staffing shortages drove state and local civilian authorities to seek federal assistance through DoD provider support to civilian hospitals. Approximately 160 Air Force medical and support personnel deployed to California, and 580 Army and Navy medical and support personnel deployed to Texas [34]. An additional team of 85 personnel from the U.S. Army Urban Augmentation Task Force, 44-person acute care team and four, seven-person Rapid Rural Response Teams from the Navy were activated to support efforts in Texas [34]. Additionally, two U.S. Naval Ships, the U.S.N.S. Comfort and U.S.N.S. Mercy, deployed to New York and Los Angeles respectively providing healthcare personnel [35]. The mission was originally to provide care to non-COVID-19 patients, however, the U.S.N.S. Comfort soon took on infected patients. Governors across numerous states mobilized National Guard members to bolster vaccination efforts [36]. Overall, over 20,000 National Guardsmen deployed in 52 states and territories and other military personnel are prepared to deploy and respond within 48 h’ notice to any requests from DHHS [37].

The MHS also faced staffing challenges of its own, with the Army reaching out to retired military doctors and medics to return to service and provide care in Military Treatment Facilities (MTFs), while troops were deployed to field settings to combat the spread of COVID-19 both in the U.S. and abroad [38,39,40]. Additionally, the MHS determined that there were not enough trained personnel to fill key pandemic response leadership roles and that more training was warranted to produce these individuals [41]. The cooperation between U.S. civilian healthcare workers and military healthcare workers has proven crucial in ensuring adequate healthcare provider staffing levels throughout the pandemic [42]. In October 2020, the death toll from COVID-19 among nurses equaled that among nurses in World War I even with data available from only a quarter of countries and the numbers have only increased since [43].

Healthcare delivery

Intricately linked to its role in human resources, the MHS has provided support to the U.S. civilian healthcare system through enabling additional delivery of services. Outpatient appointments, inpatient admissions, and surgeries dramatically decreased among patients with commercial insurance, Medicare, Medicaid, and the MHS-provided TRICARE [44,45,46]. While this freed some bed capacity to care for COVID-19 patients, the U.S. has fewer physicians and hospital beds per capita compared to other countries already overwhelmed by COVID-19, and a higher population of patients who required intensive care [33, 47]. The MHS was able to aid the civilian healthcare system by setting up field hospitals to care for civilian patients [48].

This support was provided in part through joint doctrine of DSCA as described in Governance, above [21]. Three major examples were the standup of the field hospital at the Jacob J. Javitz Convention Center in New York City in June 2020, which enabled treatment of approximately 1100 patients, the deployment of the two Naval Ships, U.S.N.S. Comfort and U.S.N.S. Mercy, to New York and Los Angeles respectively in May 2020 and the admission of non-COVID-19 patients outside the MHS to William Beaumont Army Medical Center in order to free beds in other El Paso hospital facilities in October 2020 [35, 49,50,51].

The MHS partnered with civilian entities through OWS, providing expertise in the areas of operational planning, logistics and supply chains [22, 52]. The MHS leveraged its contracting connections to obtain deals with the six manufacturers, three of which have developed vaccines currently in use [22]. The MHS also supported vaccination distribution logistics and provided manpower [22, 52]. These examples show how the rapid deployment of MHS personnel and military assets provided vital support to the U.S. civilian healthcare system during the pandemic.

Healthcare financing

The U.S. civilian healthcare system consumes 17.8% of the GDP and is the most expensive per capita in the world [53]. The MHS normally costs approximately $52 billion per year and has been holding steady at 10% of the DoD total budget since 2010 [54]. The COVID-19 pandemic took a large toll on the financing of the U.S. civilian healthcare system. While demand for specialty care to treat COVID-19 increased, demand for routine services decreased dramatically leading to reduced revenues for providers and hospitals. U.S. civilian hospitals were estimated to lose $323.1 billion in 2020 [55]. Additionally, many individuals who were laid off due to the pandemic lost their health insurance coverage and were left unable to pay to receive medical care [55]. The MHS also reduced healthcare expenditures during the pandemic due to the reduction in direct and purchased care utilization, but for the MHS this is positive savings [56]. However, there were still issues centered around financial lines of communication within the DHA and service resources. Issues occurred when it was not clear which party was responsible for funding, creating spending plans, submitting and coordinating funding requests, determining the appropriate funding source, or creating expense reports. In some cases, these financial issues caused mission delays [56]. No collaborative efforts were found during this time period between the MHS and the U.S. civilian healthcare system regarding financing.

Healthcare information

Healthcare information technology in the U.S. is composed of hundreds of electronic health record (EHR) systems, data repositories, and information systems. There is a need for increased health information exchanges across the country to improve quality of care and the COVID-19 pandemic encouraged more data sharing than previously existed.

The Tiberius platform developed by Palantir Technologies specifically for OWS response to the COVID-19 pandemic, is used to collect, correlate, and visualize data across OWS for military and civilian partners spanning the MHS as well as civilian public health and medical networks. This platform integrates data on manufacturing, supply chain, allocation, state and territory planning, and administration of the vaccine, however, no identifiable data or personal health information is contained in the platform [41]. Another useful platform, GeoHealth, a geographic information system application sponsored by the Office of the Assistant Secretary of Defense for Preparedness and Response, is used by military and civilian entities to examine burden of disease, population-level risk factors, and bed and ventilator capacity of hospitals at the county level across the U.S [57]. Both platforms have proven invaluable in tracking capacity for treatment and prevention of COVID-19.

Sharing of EHR data has been critically important when treating complex COVID-19 patients however, the majority of EHR systems are not interconnected or interoperable. To overcome this, the Joint Health Information Exchange, which is a military based data exchange, expanded to allow bidirectional data sharing from CommonWell Health Alliance, a civilian entity spanning over 15,000 hospitals and clinics [58, 59]. This data sharing allows for more efficient treatment of COVID-19 patients.

Discussion

The MHS, serves a representative population of Americans and is a crucial player in the multipronged approach to filling in the gaps in the U.S. civilian healthcare sector that have been exposed during both the PHE and pandemic as a whole. The timing and variation in the spread of COVID-19 across the U.S. has required substantial agility in the mobilization of resources, which the military medical forces were equipped to provide. This capability is supported by a well-developed research capacity, which contributed significantly to the development and testing of vaccines and therapeutics, and a dedicated logistics infrastructure which enabled rapid delivery of vaccines during OWS [22, 52]. Overall, the MHS played a vital role in the U.S. civilian healthcare sector response to the COVID-19 pandemic, with the most pronounced collaborative efforts seen in human resources, healthcare delivery, and medicine and technology.

The areas of governance, finance, and information technology presented fewer opportunities for collaborative efforts, due to fundamental differences in priorities and administration between the two systems. For instance, the varied state-level responses to the pandemic highlighted the fragmentation of care inherent throughout the U.S. civilian healthcare sector, contrasting with the centralized, mission-focused response of the MHS. Regarding healthcare financing, no collaborative efforts were found during this time period between the MHS and the U.S. civilian healthcare system, though this could change if these efforts continue. Communication between each system’s disparate information systems remains a significant challenge, and future data sharing should be addressed to ease future efforts.

Within the areas of human resources, healthcare delivery, and medicine and technology, the collaborative efforts between the MHS and U.S. civilian healthcare system provides important lessons for the continued response to the COVID-19 pandemic and future national health emergencies, including the need to continue training new generations of providers to ensure enough are available to respond, retaining capabilities for mobile medical treatment and testing facilities in the case that permanent structures are full, and continued scientific collaborative efforts between the MHS and U.S. civilian healthcare system. Together, both systems have a wealth of knowledge, skill, and ability that can work in tandem to better care for our nation, develop therapeutics, and administer them efficiently.

Limitations

This study had several limitations. First, the evolving nature of the COVID-19 pandemic means that knowledge and new literature are generated daily, and collaborative efforts between the U.S. healthcare system and the MHS continue to change in response to emerging priorities. Second, while this study presents lessons learned, it does not address hard outcomes in terms of morbidity and mortality, health service utilization, or costs. Finally, this study does not include late-breaking changes driven by the wide release of COVID-19 vaccines. Thus, this paper is intended to serve as a snapshot in time of the pandemic prior to June 2021.

Conclusion

The COVID-19 PHE has demonstrated that the U.S. civilian healthcare sector depends on the MHS and its assets to rapidly fill gaps and strengthen its capacity. The COVID-19 PHE demonstrated that the U.S. depended on the MHS and its assets in its response. It needed MHS personnel to provide direct support to hot spots across the country, to provide leadership alongside DHHS in OWS, and support regulatory social distancing. Further, our findings highlight that MHS providers have been essential in supporting their civilian counterparts during the COVID-19 PHE. Overall, the COVID-19 PHE highlighted the MHS as instrumental to the collaboration needed to address the pandemic. Therefore continuing to further develop and strengthen this partnership is necessary in preparation for continued, timely response to future PHEs.

Availability of data and materials

All information pertaining to our research is contained within the manuscript; no external datasets were used.

Abbreviations

DHHS:

Department of Health & Human Services

DoD:

U.S. Department of Defense

DSCA:

Defense Support To Civil Authorities

EHR:

Electronic health record

GDP:

Gross domestic product

MHS:

Military Health System

MTF:

Military treatment facility

OWS:

Operation warp speed

PHE:

Public Health Emergency

WHO:

World Health Organization

U.S.:

United States of America

U.S.N.S.:

U.S. Naval Ship

References

  1. Centers for Disease Control and Prevention. COVID Data Tracker: U.S. Department of Health & Human Services; 2020 [updated 2022 June 15; cited 2022 June 16]. Available from: https://covid.cdc.gov/covid-data-tracker/#datatracker-home.

  2. Office of the Assistant Secretary for Preparedness and Response. Public Health Emergency Declarations: U.S. Department of Health & Human Services; [updated 2022 May 9; cited 2022 June 16]. Available from: https://www.phe.gov/emergency/news/healthactions/phe/Pages/default.aspx.

  3. Steier J, Moxham J. The load and capacity model of healthcare delivery: considerations for the crisis management of the COVID-19 pandemic. J Thorac Dis. 2020;12:3022–30. https://doi.org/10.21037/jtd-2020-054.

    Article  PubMed  PubMed Central  Google Scholar 

  4. De Lew N, Greenberg G, Kinchen K. A layman’s guide to the U.S. health care system. Health Care Financ Rev. 1992;14:151–69.

    PubMed  PubMed Central  Google Scholar 

  5. Tikkanen R, Osborn R, Mossialos E, Djordjevic A, Wharton GA. International Health Care System Profiles: United States2020 [cited 2022 June 16]. Available from: https://www.commonwealthfund.org/international-health-policy-center/countries/united-states.

  6. Rice T, Rosenau P, Unruh LY, Barnes AJ, Saltman RB, van Ginneken E. United States of America: health system review. Health Syst Transit. 2013;15:1–431.

    PubMed  Google Scholar 

  7. Fuchs VR. Is US medical care inefficient? JAMA. 2018;320:971. https://doi.org/10.1001/jama.2018.10779.

    Article  PubMed  Google Scholar 

  8. Slaoui M, Hepburn M. Developing safe and effective Covid vaccines—operation warp speed’s strategy and approach. N Engl J Med. 2020;383:1701–3. https://doi.org/10.1056/nejmp2027405.

    Article  CAS  PubMed  Google Scholar 

  9. Knudson MM, Jacobs LM, Elster EA. How to partner with the military in responding to pandemics—a blueprint for success. JAMA Surg. 2020;155:548. https://doi.org/10.1001/jamasurg.2020.1227.

    Article  PubMed  Google Scholar 

  10. Knudson MM, Elster EA, Bailey JA, Johannigman JA, Bailey PV, Schwab CW, et al. Military-civilian partnerships in training, sustaining, recruitment, retention, and readiness: proceedings from an exploratory first-steps meeting. J Am Coll Surg. 2018;227:284–92. https://doi.org/10.1016/j.jamcollsurg.2018.04.030.

    Article  PubMed  Google Scholar 

  11. Marklund LA, Graham AM, Morton PG, Hurst CG, Motola I, Robinson DW, et al. Collaboration between civilian and military healthcare professionals: a better way for planning, preparing, and responding to all hazard domestic events. Prehosp Disaster Med. 2010;25:399–412. https://doi.org/10.1017/s1049023x00008451.

    Article  PubMed  Google Scholar 

  12. Mullick H. Miltary Aids Disaster Response Effort in the Aftermath of Hurricane Florence. Defense News [Internet]. 2018 [cited 2021 February 2]. Available from: https://www.defense.gov/Explore/News/Article/Article/1645682/military-aids-disaster-response-effort-in-the-aftermath-of-hurricane-florence/.

  13. Huff B. Task Force 51 ensures readiness for hurricane responses. Army Worldwide News [Internet]. 2020 [cited 2021 February 2]. Available from: https://www.army.mil/article/241286/task_force_51_ensures_readiness_for_hurricane_responses.

  14. Defense Health Agency. About the Military Health System Health.mil [updated 2022 June 6; cited 2022 June 16]. Available from: https://www.health.mil/About-MHS.

  15. Adirim T. A military health system for the twenty-first century. Health Aff (Millwood). 2019;38:1268–73. https://doi.org/10.1377/hlthaff.2019.00302.

    Article  Google Scholar 

  16. Monitoring the building blocks of health systems: a handbook of indicators and their measurement strategies. Health statistics and information systems: World Health Organization; 2010. p. 93.

  17. Gordon SH, Huberfeld N, Jones DK. What Federalism Means for the US Response to Coronavirus Disease 2019. JAMA Health Forum. 2020;1: e200510. https://doi.org/10.1001/jamahealthforum.2020.0510.

    Article  Google Scholar 

  18. Madhani A. What to wear: Feds’ mixed messages on masks sow confusion. AP News [Internet]. 2020 [cited 2020 November 13]. Available from: https://apnews.com/article/virus-outbreak-donald-trump-ap-top-news-politics-pandemics-26f0cb8ed836a76f0e019357cbea7f58.

  19. Esper M. Guidance for Commanders on Risk-Based Changing of Health Protection Condition Levels During the Coronavirus Disease 2019 Pandemic In: Defense Do, editor. Washington, DC: Office of the U.S. Secretary of Defense; 2020. p. 4.

  20. Defense Health Agency. About JTS: DoD Center of Excellence for Trauma [updated 2019 March 5; cited 2020 November 2]. Available from: https://jts.amedd.army.mil/index.cfm/about/about_jts.

  21. Defense Support of Civil Authorities. JP 3–28 ed. Washington, DC: Joint Chiefs of Staff.

  22. Florko N. New document reveals scope and structure of Operation Warp Speed and underscores vast military involvement2020 [cited 2022 June 16]. Available from: https://www.statnews.com/2020/09/28/operation-warp-speed-vast-military-involvement/#:~:text=%E2%80%9CThe%20Department%20of%20Defense%20has,he%20said%20in%20a%20statement.

  23. Kersey R. JBSA medical facilities support Operation Warp Speed2020 [cited 2022 June 22]. Available from: https://www.59mdw.af.mil/News/Article/2435159/jbsa-medical-facilities-support-operation-warp-speed/.

  24. Swatek G. Effort at Fort Detrick leads to approval for COVID-19 treatment. The Frederick News-Post [Internet]. 2020 [cited 2020 November 2]. Available from: https://www.fredericknewspost.com/news/continuing_coverage/coronavirus/effort-at-fort-detrick-leads-to-approval-for-covid-19-treatment/article_6d1d31c0-81cb-56fa-a25a-7c734f953c87.html.

  25. Beigel JH, Tomashek KM, Dodd LE, Mehta AK, Zingman BS, Kalil AC, et al. Remdesivir for the treatment of COVID-19—final report. N Engl J Med. 2020;383:1813–26. https://doi.org/10.1056/nejmoa2007764.

    Article  CAS  PubMed  Google Scholar 

  26. FDA Issues Emergency Use Authorization for Third COVID-19 Vaccine [press release]. FDA.gov: U.S. Food and Drug Administration2021.

  27. Centers for Disease Control and Prevention. COVID-19 Vaccinations in the United States USA.gov: Centers for Disease Control and Prevention; 2021 [updated 2022 June 15; cited 2022 June 16]. Available from: https://covid.cdc.gov/covid-data-tracker/#vaccinations_vacc-total-admin-rate-total.

  28. U.S. Department of Defense. DOD Vaccination Administration to DOD Population Defense.gov: U.S. Department of Defense; 2021 [cited 2022 June 15]. Available from: https://www.defense.gov/Spotlights/Coronavirus-DOD-Response/.

  29. Michael NL. SARS-CoV-2 in the U.S. Military—lessons for civil society. N Engl J Med. 2020;383:2472–3. https://doi.org/10.1056/nejme2032179.

    Article  CAS  PubMed  Google Scholar 

  30. Miceli S. How Can Hospitals Overcome Staffing and Supply Shortages Amid COVID-19 Surges?2020 [cited 2020 September 17]. Available from: https://www.nationalacademies.org/news/2020/08/how-can-hospitals-overcome-staffing-and-supply-shortages-amid-covid-19-surges.

  31. New AAMC Report Confirms Growing Physician Shortage [press release]. Association of American Medical Colleges, June 26 2020.

  32. American Hospital Association. ARCHIVED: Fast Facts on U.S. Hospitals, 2019: American Hospital Association; 2019 [updated Jan 2019; cited 2020 September 15]. Available from: https://www.aha.org/statistics/2020-01-07-archived-fast-facts-us-hospitals-2019.

  33. Oxford Uo. Weekly New Hospital Admissions. Our World in Data: University of Oxford; 2020.

  34. U.S. Army North Public Affairs. U.S. military deploys to Texas and California in support of COVID-19 operations. Healthmil News [Internet]. 2020 [cited 2020 September 21]. Available from: https://health.mil/News/Articles/2020/07/14/U-S-military-deploys-to-Texas-and-California-in-support-of-COVID-19-operations.

  35. Ziezulewicz G. The U.S.N.S. Comfort Is Now Taking Covid-19 Patients. Here’s What to Expect: The Navy ship’s mission in New York now comes with a new level of complexity, raising questions about whether it’s equipped for the task. The New York Times [Internet]. 2020 [cited 2020 September 21]. Available from: https://www.nytimes.com/2020/04/08/magazine/hospital-ship-comfort-new-york-coronavirus.html.

  36. Maxouris C. States call in National Guard and train volunteers to help boost vaccination pace as US hits a Covid-19 daily death toll record. CNN [Internet]. 2021 [cited 2021 January 8]. Available from: https://www.wfsb.com/news/states-call-in-national-guard-and-train-volunteers-to-help-boost-vaccination-pace-as-us/article_418e61d2-cbd6-5bc3-9adf-298b8f081c83.html.

  37. Everstine BW. DOD Deploying Medical Personnel, More on Standby As COVID-19 Cases Surge. Air Force Magazine [Internet]. 2020 [cited 2020 December 16]. Available from: https://www.airforcemag.com/dod-deploying-medical-personnel-more-on-standby-as-covid-19-cases-surge/.

  38. Grazier D. Ignored Warnings Left the Military Health System Unprepared2020 [cited 2020 September 21]. Available from: https://www.pogo.org/analysis/2020/05/ignored-warnings-left-the-military-health-system-unprepared/.

  39. Bowman T. U.S. Military Is Sending Medical Staff To COVID-19 Hotspots. The Coronavirus Crisis [Internet]. 2020 [cited 2021 February 2]. Available from: https://www.npr.org/sections/coronavirus-live-updates/2020/07/13/890553905/u-s-military-is-sending-medical-staff-to-covid-19-hotspots.

  40. Associated Press. U.S. National Guard assists as Czech Republic sounds Covid-19 alarm. NBC World News [Internet]. 2020 [cited 2021 February 2]. Available from: https://www.nbcnews.com/news/world/u-s-national-guard-assists-czech-republic-sounds-covid-19-n1245444.

  41. Simunaci L. Technology, Expertise Help Determine Vaccine Distribution. Defense News [Internet]. 2020 [cited 2021 February 4]. Available from: https://www.defense.gov/Explore/News/Article/Article/2410195/technology-expertise-help-determine-vaccine-distribution/.

  42. Hall S. DoD medical personnel work alongside civilian healthcare workers to respond to COVID-19 in El Paso, Texas. Army Worldwide News [Internet]. 2020 [cited 2020 November 23]. Available from: https://www.army.mil/article/241130/dod_medical_personnel_work_alongside_civilian_healthcare_workers_to_respond_to_covid_19_in_el_paso_texas.

  43. Mitchell G. Known COVID-19 nurse death toll 'now equal to that from WWI'. Nursing Times [Internet]. 2020 [cited 2020 November 2]. Available from: https://www.nursingtimes.net/news/coronavirus/known-covid-19-nurse-death-toll-now-equal-that-from-ww1-27-10-2020/.

  44. Jones R. Mitigating the impact of Covid-19 on Medicare Advantage risk scores and payment. MedCity News [Internet]. 2020 [cited 2020 October 19]. Available from: https://medcitynews.com/2020/09/mitigating-the-impact-of-covid-19-on-medicare-advantage-risk-scores-and-payment/.

  45. McKinsey and Company. COVID-19 impact on surgical volumes. Lecture Presented: Health Systems at the Uniformed Services University of the Health Sciences. Bethesda, MD: McKinsey and Company; 2020.

  46. Birkmeyer JD, Barnato A, Birkmeyer N, Bessler R, Skinner J. The impact of the COVID-19 pandemic on hospital admissions in the United States. Health Aff. 2020;39:2010–7. https://doi.org/10.1377/hlthaff.2020.00980.

    Article  Google Scholar 

  47. Joyce A. The U.S. Has Fewer Physicians and Hospital Beds Per Capita Than Italy and Other Countries Overwhelmed by COVID-192020 [cited 2020 November 13]. Available from: https://www.kff.org/health-costs/press-release/the-u-s-has-fewer-physicians-and-hospital-beds-per-capita-than-italy-and-other-countries-overwhelmed-by-covid-19/.

  48. Yuan L, Sherryn S, Hu P, Chen F. U.S. Field Hospitals: A Study on Public Health Emergency Response to COVID-19. medRxiv. 2020.

  49. Yuan J. Amid New York’s 42,400 hospitalizations, the military handled 3 percent. But it helped in immeasurable ways. The New York Times [Internet]. 2020 [cited 2020 December 17]. Available from: https://www.washingtonpost.com/national/new-york-javits-center-usns-comfort/2020/05/02/55abfe54-88af-11ea-8ac1-bfb250876b7a_story.html.

  50. Fuentes G. Beyond Mercy: Navy’s COVID-19 Hospital Ship Missions and the Future of Medicine at Sea2020 [cited 2020 December 18]. Available from: https://news.usni.org/2020/05/25/beyond-mercy-navys-covid-19-hospital-ship-missions-and-the-future-of-medicine-at-sea.

  51. Report K. Governor Abbott requests use of William Beaumont Army Medical Center for non-COVID patients2020 [cited 2020 October 28]. Available from: https://www.ktsm.com/local/el-paso-news/governor-abbott-requests-use-of-beaumont-medical-center-for-non-covid-patients/.

  52. Military Health System Communications Office. Hepburn: DOD role in Operation Warp Speed was ‘transformative’. Healthmil News [Internet]. 2020 [cited 2021 June 11]. Available from: https://health.mil/News/Articles/2020/12/11/Hepburn-DOD-role-in-Operation-Warp-Speed-was-transformative#:~:text=Matthew%20Hepburn's%20praise%20for%20DOD,in%20our%20DNA%E2%80%9D%20at%20DOD.

  53. Tikkanen R, Abrams MK. U.S. Health Care from a Global Perspective, 2019: Higher Spending, Worse Outcomes?2020 [cited 2020 October 12]. Available from: https://www.commonwealthfund.org/publications/issue-briefs/2020/jan/us-health-care-global-perspective-2019.

  54. Mendez BHP, Kamarck KN, Kapp L, Ott A, Torreon BS. FY2020 National Defense Authorization Act: Selected Military Personnel Issues. Congressional Research Service, 2020 Sept 18, 2020. Report No.: Contract No.: R46107.

  55. Blumenthal D, Fowler EJ, Abrams M, Collins SR. Covid-19—implications for the Health Care System. N Engl J Med. 2020;383:1483–8. https://doi.org/10.1056/nejmsb2021088.

    Article  CAS  PubMed  Google Scholar 

  56. Adirim T. Regarding the Military Health System Before the Senate Appropriations Commitee Defense Subcommitee. United States Senate Committee on Appropriations; 2021. p. 20.

  57. U.S. Department of Health & Human Services. Department of Health & Human Services - ASPR GIS: Assistant Secretary for Preparedness and Response; 2017 [cited 2020 November 9]. Available from: https://asprgis.hhs.gov/GISSupport/pages/default.aspx.

  58. Defense Health Agency. Joint Health Information Exchange Health.mil: Defense Health Agency; [cited 2020 October 13]. Available from: https://www.health.mil/Military-Health-Topics/Technology/Joint-HIE.

  59. Federal Electronic Health Record Connects With More Community Partners [press release]. U.S. Department of Defense, October 13 2020.

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Koehlmoos, T.P., Korona-Bailey, J., Janvrin, M.L. et al. The collaborative research and service delivery partnership between the United States healthcare system and the U.S. Military Health System during the COVID-19 pandemic. Health Res Policy Sys 20, 81 (2022). https://doi.org/10.1186/s12961-022-00885-4

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