Military health care in the 21st century.

: This paper describes the pressures for health care reform which are impinging on the United States health care system. These are costs, access, allocation of resources, unnecessary care, and administrative costs and confusion. The implications of these pressures for military health care are considered to be the redefinition of the health benefit, restructuring of the military health care system, and questions about the appropriate role for the reserve components. Ten persistent issues are identified which will need to be addressed, regardless of whatever changes are proposed in the immediate future. These are the quality of health care, improved management of the military health care system, costs of care including pharmaceuticals, recruitment and retention of health care professionals, graduate medical education, renewed emphasis on health promotion and disease prevention, discharge planning and patient education, development and diffusion of new technologies, information management, and the management of environmental waste.