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The Military Health System in Transition: Revisiting Avoidable Hospitalizations (Fiscal Years 2021-2024)
Mark J Meuer1, Wendy Vaughan1,2, Amanda Banaag1,2
1Center for Health Services Research, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, United States.
Military Medicine
|January 20, 2026
Summary
Military beneficiaries with private primary care managers (PCMs) had fewer avoidable hospitalizations. This suggests direct care capabilities may be impacted by staffing shortages within the Military Health System (MHS).
Area of Science:
- Health Services Research
- Military Health
- Quality Improvement
Background:
- The Military Health System (MHS) has undergone significant transformations, including the Defense Health Agency (DHA) merger, MHS GENESIS deployment, facility realignments, and the COVID-19 pandemic.
- These changes may impact the quality and accessibility of care for MHS beneficiaries.
Purpose of the Study:
- To compare the rates of avoidable hospitalizations among MHS beneficiaries based on whether their primary care manager (PCM) was in the direct care (military treatment facility) or private sector.
- To assess the impact of recent MHS changes on beneficiary care quality.
Main Methods:
- A cross-sectional study analyzed TRICARE Prime beneficiaries (18-64 years) from fiscal years 2021-2024 using the MHS Data Repository.
- Agency for Healthcare Research and Quality (AHRQ) Prevention Quality Indicators (PQIs) were used to identify avoidable hospitalizations.
- Crude and adjusted risk ratios, and logistic regression models were employed to compare outcomes between direct care and private sector PCMs.
Main Results:
- A total of 490,236 hospital admissions were analyzed, with 2.85% associated with PQIs.
- While initial rates suggested fewer avoidable hospitalizations for direct care PCMs, adjusted analysis revealed a lower overall risk for beneficiaries with private sector PCMs (3.75% vs. 2.70%).
- Black race and comorbidities were associated with higher odds of avoidable hospitalization.
Conclusions:
- Beneficiaries managed by private sector PCMs demonstrated lower odds of avoidable hospitalizations.
- Findings indicate potential impacts of staffing shortages on direct care capabilities within the MHS.
- MHS stabilization is crucial for maintaining a ready medical force to support military readiness.
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