Research for Access

The Director of Medical Resources, Plans,and Policy Division (N931) asked The Center for Naval Analyses (CNA) to conduct an assessment of the feasibility of converting OCONUS active duty Navy medical billets to civilians. This feasibility assessment focuses on the impact of executing billet conversions as they relate to costs, quality of care, access to care, recruitment and retention, and medical readiness. Based on the billets provided for us consideration for conversion, we estimated the costs of the military billets and the costs of non-military personnel options for these same billets, including hiring local nationals; dependents of military assigned OCONUS; relocating civil service or contract employees from CONUS; and expanding the preferred provider network overseas. We estimated potential costs savings using an incremental approach starting with potential savings estimates without regard to whether the conversions are feasible. Then, we applied various feasibility constraints to provide cost savings estimates in more realistic scenarios based on the availability and actual likelihood of acquiring qualified substitutes for military health professionals. Although there are opportunities to civilianize some Navy active duty OCONUS medical billets, we find that there are substantial risks involved with the magnitude of the conversions as defined by the Quadrennial Defense Review