美军平时医疗保障及其改革研究
|
摘要
随着我军医疗保障改革的不断推进和深化，目前已经取得了明显成效，新型的军队医疗保障制度基本形成，军人医疗保障水平明显提高。但由于多方面原因，我军现行医疗保障体制还存在政策制度不够完善，官兵就医不够方便，就医渠道相对单一，保障效能不够高，经费保障水平尚有差距，激励机制有待健全，服务监管需要加强等矛盾和问题，需要不断改进和完善。美军医疗保障系统可以说是世界上最为庞大和先进的军队医疗保障系统。美军医疗保障体系自19世纪70年代建立至今，也曾经暴露出许多不足与弊端，如20世纪50年代的医疗保障需求快速增长，医疗保障系统无法满足需求，以及90年代初的保障费用暴涨、医疗服务质量和效率极端低下等，迫使美军医疗保障体系不断进行改革创新，持续推行新的医疗保障计划。美军先后推行了紧急产科和婴儿保健系统计划（EMIC）、武装部队民间医疗卫生系统计划（CHAMPUS）、CHAMPUS改革试点计划（CRI）等，最终探索出目前采用的相对完善的TRICARE医疗保障计划。近几年来，美军更加重视医疗保障改革的问题，专门成立了医疗保障改革专家组，每年对TRICARE系统的医疗保障项目进行评估，提出改革建议并制定未来规划，且很多改革措施已经取得了阶段性成效，在一定程度上促进了医疗服务质量的提升，同时能够有效控制卫生经费，可为我军医疗保障改革提供借鉴和参考。
本研究采用文献调研、系统分析、综合分析和专家咨询相结合的研究方法，从深化我军医疗保障改革中存在的问题和困难为着眼点，并以美军平时医疗保障改革中的热点、亮点为牵引，系统追踪最近几年来美军的平时医疗保障改革方案与措施，分析其改革动因并评价其成效，重点挖掘美军平时医疗保障系统在组织体制改革、医疗保障费用控制、药品保障管理、诊疗制度改革等方面的经验，为我军医疗保障改革提供借鉴和参考。
研究内容分为以下六部分：
第一部分系统回顾梳理了美军平时医疗保障制度的历史沿革，分析了美军医疗保障理念、医疗保障对象结构、保障类型和个人付费的现状与变化趋势。美军医疗保障对象覆盖范围广，规模大，且呈现规模不断增加和老龄化的趋势。美军医疗保障类型发展相对稳定，但也进行了一些与时俱进的改革，个人付费水平十几年来涨幅微小。
第二部分研究了美军平时医疗保障组织管理体系及其改革。美军在国防部设立平时医疗保障的最高领导机构，建立了分工细化的职能管理机构，实施划区联勤保障。美军的医疗服务体系由军队医疗服务体系和地方医疗服务体系共同组成。目前美军正在进行区域一体化医疗保障模式改革的尝试与探索，且取得了节约资源，提高服务质量和可及性的实施效果。未来MHS组织体系改革方向很可能是：采用―组建国防卫生局，医疗机构仍归各军种管理‖的模式。
第三部分，系统研究了美军诊疗制度的现状及其改革热点，主要包括初级保健模式、预防医学服务、伤病员康复保障、心理健康保障的现状及其改革动因、措施、效果与经验分析，以及牙科医疗服务现状和医疗服务质量改进措施研究。
第四部分，系统研究了美军药品保障制度的现状及其改革热点，主要研究了美军现行药品保障的管理机构与管理机制，分析了近年来美军在用药安全管理、药品经费控制和药学服务质量改进等方面的改革措施、效果及经验。
第五部分，研究了美军平时医疗保障经费的来源、数量、分析了美军医疗保障经费不断增长的原因和经费控制措施，探讨了美军医疗保障经费未来的发展趋势。
第六部分，归纳总结了美军平时医疗保障改革经验，即保障理念与时俱进——需求导向；保障类型灵活多样——付费有别；保障体系重组优化——精简高效；保障程序简化便利——易于操作；改革措施依托科技——信息主导；保障经费稳步增长——合理控制。结合我军平时医疗保障改革面临的问题与困难，提出美军平时医疗保障及其改革经验对我军的启示：转变医疗保障理念；优化军队医疗保障体系；完善军队医疗保障措施;改进经费预算与管理。
With the further deepening of reform in China‘s military health care system,some remarkable success has been achieved. For example, a new type of militarymedical insurance system has been basically established and soldiers‘health care levelhas been significantly improved. However, due to various reasons, there are still somecontradictions and problems in China‘s existing military health care system, includingimperfect policy and institution, inconvenient access progress for treatment, relativelyfewer option of health care provider, Inefficient health care, Insufficient health funds,unsound incentives and supervision to be strengthened. US military health caresystem is the biggest and advanced military health care system in the world, whichhas also been exposed to lots of shortcomings and drawbacks since its establishmentin the1870s. These problems, such as rapid increasing demand of health care whichcould not be met in the1950s, health care cost soaring and extremely low quality andefficiency of medical service in the early1990s, forced the US military health system(MHS) keep innovate by launching new health care programs. US MHS has launchedthe Emergency Maternal and Infant Care Program (EMIC), Civilian Health andMedical Program of the Uniformed Services (CHAMPUS), CHAMPUS ReformInitiative (CRI), and ultimately established current TRICARE plan which is relativelysophisticated. In recent years, MHS has attached more importance to health carereform. MHS has set up a special working group on reform, which evaluatesTRICARE program every year and gives recommendations to the future reform ofTRICARE. Some of the reform measures has contributed to the enhancement of thehealth service quality and cost control to some extent since being put into effect,which provides us valuable experiences and enlightenments.
In this study, literature survey, systems analysis, comprehensive analysis andexpert consultation are used to systematically study the reform plan and measures ofUS military health care in peace time, to analyze the impetus to reform and evaluatethe effect of the reform, starting from the problems and difficulties in China‘s militaryhealth care system, guiding by hot points and highlights in U.S. military health carereform. More attention is paid on the reform of command and control structure tomanage MHS, measures to control the health care cost, pharmaceutical managementdevelopment and medical system reform to provide reference for our military healthcare system reform.
The research consists of six parts:
In the first part, the evolution of US military health care system is reviewed, thedevelopment of health care concept focusing on the changing demand of war andbeneficiary is surveyed, and the current status and variation tendency of beneficiarystructure, health care type and out-of-pocket payment are analyzed. TRICARE coversa wide range of beneficiary, which is in high quantity and showed the trend ofincreasing scale and aging. The health care type keeps relatively stable, in addition tosome progressive adjustment. The out-of-pocket keeps stable too with slight increasein more than a decade.
The second part studies the command and control structure to manage US MHSand its reform. The highest lead Agency to manage military health care in peace timeis set in US Department of Defense (DOD), with specialized functional managementinstitutions, delivering health care in divided regions. Currently, MHS is exploring theintegrated health care delivery in one region and has saved district resources andimproved access to care and quality. Possible reform direction of MHS organization isto establish a defense health agency with military treatment facilities (MTFs)remaining with the military departments.
The third part provides an in-depth study on current situation and reform of theUS military medical system, in which the motivation and implementing effect ofprimary care model reform are explored, the status, reform motivation, measures,implementing effect and experiences of preventive health care service, warriorrehabilitation and mental health service are analyzed, dental service status andmedical service quality improvement measures are surveyed.
In the fourth part, by reviewing and analyzing US military innovative measuresand effects on drug cost control, medication safety management and service qualityimprovements in recent years, some enlightenment for Chinese army‘s pharmaceuticalmanagement is put forward.
In the fifth part, the resource and amount of the US military health funds aresurveyed, the cause of sustained rise of health care cost and measures for cost controlare analyzed and the future development trend of the US military health care cost areinvestigated.
The sixth part serves as a summary of the experiences of US military health careand its reform as well as the problems and difficulties faced in China‘s military healthcare. Some enlightenment is proposed that is altering the concept of China‘s militaryhealth care, optimizing the military health care system, perfecting military health caremeasures and improving funds budget and management.
本研究采用文献调研、系统分析、综合分析和专家咨询相结合的研究方法，从深化我军医疗保障改革中存在的问题和困难为着眼点，并以美军平时医疗保障改革中的热点、亮点为牵引，系统追踪最近几年来美军的平时医疗保障改革方案与措施，分析其改革动因并评价其成效，重点挖掘美军平时医疗保障系统在组织体制改革、医疗保障费用控制、药品保障管理、诊疗制度改革等方面的经验，为我军医疗保障改革提供借鉴和参考。
研究内容分为以下六部分：
第一部分系统回顾梳理了美军平时医疗保障制度的历史沿革，分析了美军医疗保障理念、医疗保障对象结构、保障类型和个人付费的现状与变化趋势。美军医疗保障对象覆盖范围广，规模大，且呈现规模不断增加和老龄化的趋势。美军医疗保障类型发展相对稳定，但也进行了一些与时俱进的改革，个人付费水平十几年来涨幅微小。
第二部分研究了美军平时医疗保障组织管理体系及其改革。美军在国防部设立平时医疗保障的最高领导机构，建立了分工细化的职能管理机构，实施划区联勤保障。美军的医疗服务体系由军队医疗服务体系和地方医疗服务体系共同组成。目前美军正在进行区域一体化医疗保障模式改革的尝试与探索，且取得了节约资源，提高服务质量和可及性的实施效果。未来MHS组织体系改革方向很可能是：采用―组建国防卫生局，医疗机构仍归各军种管理‖的模式。
第三部分，系统研究了美军诊疗制度的现状及其改革热点，主要包括初级保健模式、预防医学服务、伤病员康复保障、心理健康保障的现状及其改革动因、措施、效果与经验分析，以及牙科医疗服务现状和医疗服务质量改进措施研究。
第四部分，系统研究了美军药品保障制度的现状及其改革热点，主要研究了美军现行药品保障的管理机构与管理机制，分析了近年来美军在用药安全管理、药品经费控制和药学服务质量改进等方面的改革措施、效果及经验。
第五部分，研究了美军平时医疗保障经费的来源、数量、分析了美军医疗保障经费不断增长的原因和经费控制措施，探讨了美军医疗保障经费未来的发展趋势。
第六部分，归纳总结了美军平时医疗保障改革经验，即保障理念与时俱进——需求导向；保障类型灵活多样——付费有别；保障体系重组优化——精简高效；保障程序简化便利——易于操作；改革措施依托科技——信息主导；保障经费稳步增长——合理控制。结合我军平时医疗保障改革面临的问题与困难，提出美军平时医疗保障及其改革经验对我军的启示：转变医疗保障理念；优化军队医疗保障体系；完善军队医疗保障措施;改进经费预算与管理。
With the further deepening of reform in China‘s military health care system,some remarkable success has been achieved. For example, a new type of militarymedical insurance system has been basically established and soldiers‘health care levelhas been significantly improved. However, due to various reasons, there are still somecontradictions and problems in China‘s existing military health care system, includingimperfect policy and institution, inconvenient access progress for treatment, relativelyfewer option of health care provider, Inefficient health care, Insufficient health funds,unsound incentives and supervision to be strengthened. US military health caresystem is the biggest and advanced military health care system in the world, whichhas also been exposed to lots of shortcomings and drawbacks since its establishmentin the1870s. These problems, such as rapid increasing demand of health care whichcould not be met in the1950s, health care cost soaring and extremely low quality andefficiency of medical service in the early1990s, forced the US military health system(MHS) keep innovate by launching new health care programs. US MHS has launchedthe Emergency Maternal and Infant Care Program (EMIC), Civilian Health andMedical Program of the Uniformed Services (CHAMPUS), CHAMPUS ReformInitiative (CRI), and ultimately established current TRICARE plan which is relativelysophisticated. In recent years, MHS has attached more importance to health carereform. MHS has set up a special working group on reform, which evaluatesTRICARE program every year and gives recommendations to the future reform ofTRICARE. Some of the reform measures has contributed to the enhancement of thehealth service quality and cost control to some extent since being put into effect,which provides us valuable experiences and enlightenments.
In this study, literature survey, systems analysis, comprehensive analysis andexpert consultation are used to systematically study the reform plan and measures ofUS military health care in peace time, to analyze the impetus to reform and evaluatethe effect of the reform, starting from the problems and difficulties in China‘s militaryhealth care system, guiding by hot points and highlights in U.S. military health carereform. More attention is paid on the reform of command and control structure tomanage MHS, measures to control the health care cost, pharmaceutical managementdevelopment and medical system reform to provide reference for our military healthcare system reform.
The research consists of six parts:
In the first part, the evolution of US military health care system is reviewed, thedevelopment of health care concept focusing on the changing demand of war andbeneficiary is surveyed, and the current status and variation tendency of beneficiarystructure, health care type and out-of-pocket payment are analyzed. TRICARE coversa wide range of beneficiary, which is in high quantity and showed the trend ofincreasing scale and aging. The health care type keeps relatively stable, in addition tosome progressive adjustment. The out-of-pocket keeps stable too with slight increasein more than a decade.
The second part studies the command and control structure to manage US MHSand its reform. The highest lead Agency to manage military health care in peace timeis set in US Department of Defense (DOD), with specialized functional managementinstitutions, delivering health care in divided regions. Currently, MHS is exploring theintegrated health care delivery in one region and has saved district resources andimproved access to care and quality. Possible reform direction of MHS organization isto establish a defense health agency with military treatment facilities (MTFs)remaining with the military departments.
The third part provides an in-depth study on current situation and reform of theUS military medical system, in which the motivation and implementing effect ofprimary care model reform are explored, the status, reform motivation, measures,implementing effect and experiences of preventive health care service, warriorrehabilitation and mental health service are analyzed, dental service status andmedical service quality improvement measures are surveyed.
In the fourth part, by reviewing and analyzing US military innovative measuresand effects on drug cost control, medication safety management and service qualityimprovements in recent years, some enlightenment for Chinese army‘s pharmaceuticalmanagement is put forward.
In the fifth part, the resource and amount of the US military health funds aresurveyed, the cause of sustained rise of health care cost and measures for cost controlare analyzed and the future development trend of the US military health care cost areinvestigated.
The sixth part serves as a summary of the experiences of US military health careand its reform as well as the problems and difficulties faced in China‘s military healthcare. Some enlightenment is proposed that is altering the concept of China‘s militaryhealth care, optimizing the military health care system, perfecting military health caremeasures and improving funds budget and management.
引文
[1]军队医改评估调研组.全军医改评估调研报告.总后卫生部，2009，4
[3]张良,张琪.对美军医疗保健体制(MHS)改革演化的分析.西南国防医药,2008,18(5):754-755.
[4]刘鹏虎,李明庚.美军医疗保障体制改革.军事经济研究,1994(8):88-90.
[6]张雁灵，刘胡波，刁天喜.美国军队卫勤保障.北京:军事医学科学出版社,2010.
[7]雷二庆,毛玉明,吴乐山.透视美军部队健康全面保护构想军事医学科学院院刊,2004,28(2):168-170.
[11] Steven Schroede. We Can Do Better--Improving the Health of the American People.N Engl J Med,2007(357):1221-1228.
[46]John Holman, Thomas Wickizer. Family Physician Resource Use for Inpatient Care: AComparison between Military Medical Center and Community Hospital. Military Medicine,2006,171(5):365-369.
[48]胡爱平，王明叶.美国的医疗服务与医疗保险[M].北京：高等教育出版社.2010.
[49] Murray JS. Joint Task Force National Capital Region Medical: Integration of Education,Training, and Research. Mil Med,2009,174(5):448-454.
[50] De Lorenzo RA. San Antonio Military Medical Center Integration: A Case Study inOrganizational Leadership Design. Mil Med,2008,173(2):203-209.
[53] Paul B. BRAC revamps system: Changes Affect Delivery Of Healthcare By Military.Modern Healthcare(Modern Healthcare35th Anniversary),2011(8):38.
[54]赵晓宇,刁天喜.美军―圣安东尼奥地区军队卫生系统‖简介.人民军医,2013(1):34-35.
[55] Department Of Defense. Task Force On Military Health System Governance. http://health.mil/MHSGovernanceReport/Enclosure%202%20-%20Volume%201%20revised.pdf,Accessed2011-09-29.
[56]赵晓宇,刁天喜.美军初级医疗保健模式改革.解放军医院管理杂志,2012(10):996-998.
[58] Marshall RC, Doperak M, Milner M, et al. Patient-Centered Medical Home: An Emerging Primary Care Model and the Military Health System. Mil Med,2011,176(11):1253-9.
[64]杨永燕.医疗模式在美国获推崇.中国信息界(e医疗),2011(05):19
[65]赵晓宇.外军卫勤研究系列讲座(42)美军平时医疗保障发展动向.人民军医,2011(6):461-462.
[66]赵晓宇,刁天喜,楼铁柱.美军平时医疗保障概况与改革进展.军事医学,2012(9):707-709.
[71]李培进.美国国防部士兵康复计划的启示.解放军健康，2009(4):38.
77李刚.美军口腔卫生勤务和口腔医疗管理现状.人民军医,2011,54(3):185-187.
[78]王军，李广文，吕波涛等.美军牙科大队情况简介（上）.人民军医,2012,55(7):606-607.
[79]王军，李广文，吕波涛等.美军牙科大队情况简介（下）.人民军医,2012,55(8)：712-713.
[80]李刚.美军口腔卫生勤务和口腔医疗管理现状.人民军医,2011,54(3):185-187.
[81]李广文，王军，张燕.国外航空母舰牙科资源配置及勤务保障研究.2012,14(01):183-184
[88]蒯丽萍，张晓东.美军平时医疗用药政策的启示.军事医学,2012,36(9):704-706.
[90]Gordon R. Admiral Thomas J. Mcginnis:Managing Pharmacy Benefits Within the Milit
[93]Jansen DJ, Blakeley Katherine. Military Medical Care: Questions and Answers. http://www.crs.gov.2013-01-30.
[96]赵晓宇，刁天喜.美军药品保障管理进展.军事医学，2012,36(12):159-161.
[99]张奇林.美国的医疗卫生费用及其控制.世界经济.2002,(6):53-59.
[100]张奇林.论美国的医疗卫生费用控制.美国研究.2002,(01):70-79
[101]张奇林.美国医疗保障制度研究.北京:人民出版社，2005.
[103] Jeff Tzeng, Christopher J, Hayley H. Cost-Minimization Analysis of the U.S. ArmyAccession Screening and Immunization Program. Mil Med,2012,177(12):1508-1512.
[104]许顺雄,郭树森,刘双全.军队医疗保障制度改革现状及发展趋势.中国社会医学杂志,2006,23(1):23-25.
[105]刘敏，贺桢，潘景光等.军队医疗保障制度改革的思考.解放军医院管理杂志,2012,19(2):171-172.
[106]马玉琴;张鹭鹭;杨国士;刘源.军队医疗卫生费用拨款状况分析.中国卫生经济.2009,28(2):7-8.
[107]马守江;张东军队卫生资源配置与合理利用.实用医药杂志.2008,25(12):1528.
[108]刘文清;公斌;时利民.军队医院合理医疗的思考.实用医药杂志,2007,6(6):767-768.
[109]军队医疗保障制度改革专项论证组.深化军队医疗保障制度改革研究论证报告.总后卫生部，2008.
[111]姚伟飚.谈美国DRG管理制度及在我国军队医疗成本核算中的发展.会计之友(上旬).2007(04):37-38.
1.军队医改评估调研组.全军医改评估调研报告.总后卫生部，2009，4
2. Spring B. Saving the American Dream: Improving Health Care and Retirement for Military Service Members and Their Families. http://www.heritage.org/research/reports/2011/11/saving-the-american-dream-improving-health-care-and-retirement-for-military-service-members, Accessed2011-11-17.
3.张良,张琪.对美军医疗保健体制(MHS)改革演化的分析.西南国防医药,2008,18(5):754-75
5.
4.刘鹏虎,李明庚.美军医疗保障体制改革.军事经济研究,1994(8):88-90.
5.张雁灵,刘胡波,刁天喜.美国军队卫勤保障[M].北京:军事医学科学出版社,2010.
6.雷二庆,毛玉明,吴乐山.透视美军部队健康全面保护构想军事医学科学院院刊,2004,28(2):168-170.
7. The Evaluation of the TRICARE Program:Fiscal Year2010Report to Congress.http://www.tricare.mil/tma/downloads/TRICARE201002_28_10v7.pdf, Accessed2010-01-20.
8. Steven Schroede. We Can Do Better--Improving the Health of the American People.N Engl J Med,2007(357):1221-1228.
9. The Evaluation of the TRICARE Program: Fiscal Year2011Report to Congress. http://www.tricare.mil/tma/downloads/TRICARE2011_02_28_11v8.pdf, Accessed2011-03-20.
10. The Evaluation of the TRICARE Program: Fiscal Year2012Report to Congress.http://www.tricare.mil/tma/dhcape/program/downloads/TRICARE2012_02_28v5.pdf, Accessed2012-04-28.
11. TRICARE Prime and TRICARE Prime Remote Handbook.2012. http://www.humana-military.com/.../pdf/prime-remote-handbook.pdf, Accessed2012-09-10.
12. TRICARE Standard Handbook2012. http://www.humana-military.com/library/pdf/standard-handbook.pdf, Accessed2012-08-10.
13. TRICARE Standard Handbook2012. http://www.humana-military.com/library/pdf/standard-handbook.pdf, Accessed2012-08-10.
14. TRICARE Reserve Select. http://www.military.com/benefits/tricare/guard-and-reserve/tricare-reserve-select-overview.html, Accessed2012-11-12
15. TRICARE Choices.2006. http://www.humana-military.com/library/pdf/choices-handbook.pdf, Accessed2012-08-10.
16. TRICARE For Life. http://www.military.com/benefits/tricare/retiree/tricare-for-life.html.Accessed2012-12-02.
17. TRICARE Young Adult. http://www.tricare.mil/tya/.2012-12-20, Accessed2013-12-02.
18. US Family Health Plan. http://www.tricare.mil/Welcome/Plans/USFHP.aspx, Accessed2012-12-09.
19. Department of Defense, Subcommittee of the Defense Health Board,―Report of theTask Force on the Future of Military Health Care,‖December2007, p.92. http://www.dcoe.health.mil/Content/Navigation/Documents/103-06-2-Home-Task_Force_FINAL_REPORT_122007.pdf, Accessed2010-11-10.
20. Prime Enrollment Fees. http://www.tricare.mil/Welcome/Enrollment/TP/EnrollmentFees.aspx, Accessed2011-12-03.
21. RICARE Standard and Extra costs. http://www.tricare.mil/standardcosts/, Accessed2011-12-03.
22. About TMA.http://www.tricare.mil/tma/AboutTMA.aspx,Accessed2010-10-11.
23. TRICARE Management Activity Organization chart. http://search.yahoo.com/r/_ylt=A0oGdW6fOVlRs00Ay7tXNyoA;_ylu=X3oDMTE1azMydnNrBHNlYwNzcgRwb3MDNQRjb2xvA3NrMQR2dGlkA1ZJUDEzMV8xNjQ-/SIG=12vo0h68a/EXP=1364830751/**http%3a//www.documbase.com/TRICARE-Management-Activity-Organization-Chart.pdf, Accessed2011-11-07.
24. About CAP. http://www.cap.mil/AboutCAP/AboutCAP.aspx, Accessed2010-10-07.
25. About DoD Patient Safety Program. http://www.health.mil/dodpatientsafety/AboutUs.aspx, Accessed2010-11-02. http://www.tricare.mil/fraud/, Accessed2010-09-02
26. Mission Statement. http://www.tricare.mil/tma/MMSO/, Accessed2011-08-12.
27. TMA Privacy and Civil Liberties Office. http://www.tricare.mil/tma/privacy/,Accessed2012-02-12.
28. TRICARE, SAIC Report Loss Of Data On4.9Million beneficiaries. http://search.yahoo.com/r/_ylt=A0oGdUsAPllRhyIA9UNXNyoA;_ylu=X3oDMTE1a3Z1aDF2BHNlYwNzcgRwb3MDNwRjb2xvA3NrMQR2dGlkA1ZJUDEzMV8xNjQ-/SIG=11ng52okj/EXP=1364831872/**http%3a//www.phiprivacy.net/%3fp=7854, Accessed2011-11-07.
29. Senior Enlisted Advisor's Mission. http://www.tricare.mil/tma/aboutTMA/sea/default.aspx, Accessed2011-11-10.
30. Defense Health Cost Assessment and Program Evaluation (DHCAPE). http://www.tricare.mil/tma/dhcape/, Accessed2011-12-13.
31. TRICARE Service Centers. http://www.tricare.mil/tma/TSC.aspx,Accessed2012-12-10.
32. Acquisition Management and Support (AM&S) Directorate. http://www.tricare.mil/tma/AMS/default.aspx, Accessed2012-12-10.
33. Acquisition Management and Support Directorate Chart. http://search.yahoo.com/r/_ylt=A0oGdW6fOVlRs00Ay7tXNyoA;_ylu=X3oDMTE1azMydnNrBHNlYwNzcgRwb3MDNQRjb2xvA3NrMQR2dGlkA1ZJUDEzMV8xNjQ-/SIG=12vo0h68a/EXP=1364830751/**http%3a//www.documbase.com/TRICARE-Management-Activity-Organization-Chart.pdf, Accessed2011-11-07.
34. http://dhims.health.mil/, Accessed2010-12-23.
35. http://www.health.mil/MHSCIO/programs_products/DHSS.aspx, Accessed2010-12-23.
36. Defense Health Services Systems (DHSS) Chart. http://search.yahoo.com/r/_ylt=A0oGdW6fOVlRs00Ay7tXNyoA;_ylu=X3oDMTE1azMydnNrBHNlYwNzcgRwb3MDNQRjb2xvA3NrMQR2dGlkA1ZJUDEzMV8xNjQ-/SIG=12vo0h68a/EXP=1364830751/**http%3a//www.documbase.com/TRICARE-Management-Activity-Organization-Chart.pdf,Accessed2011-11-07.
37. Office of General Counsel Chart. http://search.yahoo.com/r/_ylt=A0oGdW6fOVlRs00Ay7tXNyoA;_ylu=X3oDMTE1azMydnNrBHNlYwNzcgRwb3MDNQRjb2xvA3NrMQR2dGlkA1ZJUDEzMV8xNjQ-/SIG=12vo0h68a/EXP=1364830751/**http%3a//www.documbase.com/TRICARE-Management-Activity-Organization-Chart.pdf, Accessed2011-11-07.
38. TRICARE North Region.http://www.tricare.mil/tma/AboutTMA.aspx,Accessed2011-12-0
7.
39. Office of Deputy Director, TRICARE Regional Operations TRICARE Regional Office–North. http://search.yahoo.com/r/_ylt=A0oGdW6fOVlRs00Ay7tXNyoA;_ylu=X3oDMTE1azMydnNrBHNlYwNzcgRwb3MDNQRjb2xvA3NrMQR2dGlkA1ZJUDEzMV8xNjQ-/SIG=12vo0h68a/EXP=1364830751/**http%3a//www.documbase.com/TRICARE-Management-Activity-Organization-Chart.pdf,, Accessed2011-11-07.
40. Access to care about army medicine. http://www.medicine.army.mil/hc/medfacilities/CommandControl.htm, Accessed2011-11-07.
41. John Holman, Thomas Wickizer. Family Physician Resource Use for Inpatient Care: AComparison between Military Medical Center and Community Hospital. Military Medicine,2006,171(5):365-369.
42. Careers&Jobs. http://chaplian.goarmy.com/JobCatDetail.do?id=9, Accessed2012-08-06.
43.胡爱平，王明叶.美国的医疗服务与医疗保险.北京：高等教育出版社.2010.
44. Murray JS. Joint Task Force National Capital Region Medical: Integration of Education, Training, and Research. Mil Med,2009,174(5):448-454.
45. De Lorenzo RA. San Antonio Military Medical Center Integration: A Case Study inOrganizational Leadership Design. Mil Med,2008,173(2):203-209.
46. Joint Task Force National Capital Region Medical. http://www.boozallen.com/media/file/JTF-National-Capital-Regional-Medical-cs.pdf, Accessed2013-03-09.
47. Joint Task Force National Capital Region/Medical. http://en.wikipedia.org/wiki/Joint_Task_Force_National_Capital_Region/Medical, Accessed2013-02-09.
48. Paul B. BRAC revamps system: Changes Affect Delivery Of Healthcare By Military.Modern Healthcare(Modern Healthcare35th Anniversary),2011(8):38.
49.赵晓宇,刁天喜.美军―圣安东尼奥地区军队卫生系统‖简介.人民军医,2013,56(1):34-35.
50. Department Of Defense. Task Force On Military Health System Governance. http://health.mil/MHSGovernanceReport/Enclosure%202%20-%20Volume%201%20revised.pdf, Accessed2011-09-29.
51.赵晓宇,刁天喜.美军初级医疗保健模式改革.解放军医院管理杂志,,2012,19(10):996-998.
52. Military Healthcare Professionals Gather For Annual MHS Conference. http://www.usmedicine.com/news/2012/01/31/military-healthcare-professionals-gather-for-annual-mhs-conference.html, Accessed2012-01-31.
53. Philpott T. Care Seen Rising Under 'Medical Home' Concept. http://www.military.com/features/0,15240,226300,00.html, Accessed2012-02-20.
54. Military Health System Patient Centered Medical Home Guide2011-06-01. http://www.tricare.mil/tma/ocmo/download/MHSPCMHGuide.pdf, Accessed2011-12-01.
55. Marshall RC, Doperak M, Milner M, et al. Patient-Centered Medical Home: An Emerging Primary Care Model and the Military Health System. Mil Med,2011,176(11):1253-1259.
56. Operation Order (OPORD)11-20, Army Patient Centered Medical Home. http://www.tricare.mil/tma/ocmo/download/MHSPCMHGuide. pdf, Accessed2011-11-01.
57. DoD and VA pursue PCMH model. http://www.govhealthit.com/news/dod-and-va-pursue-pcmh-model, Accessed2012-01-03.
58. Policy Memorandum Implementation of the Patient Centered Medical HomeModel ofPrimary Care in MTFs. http://www.usafp.org/PCMH-Files/DoD-Files/PCMH-Policy-Memo--signed-18-Sep-09.pdf. Accessed2009-09-18.
59.赵晓宇.外军卫勤研究系列讲座(42)美军平时医疗保障发展动向.人民军医,2011,54(6):461-462.
60.赵晓宇,刁天喜,楼铁柱.美军平时医疗保障概况与改革进展.军事医学,2012,36(9):707-7
09.
61. Operation Live Well Focuses on Healthy Living. http://www.health.mil/News_And_Multimedia/News/detail/13-01-14/Operation_Live_Well_Focuses_on_Healthy_Living.aspx, Accessed2013-01-14.
62. TRICARE Expands Retail Pharmacy Vaccine Program. http://tricare.mil/Welcome/MediaCenter/News/Archives/51_ExpandedVaccineProgram.aspx?NavContext={68EF1CC1-D05F-485B-883A-E24160FE942A}, Accessed2011-08-22.
63. About WTC.http://wtc.armylive.dodlive.mil/about-wtc/, Accessed2011-08-22.
64.走进美军坎贝尔堡士兵康复中心. http://article.yeeyan.org/view/95021/124657,Accessed2011-08-22.
65.李培进.美国国防部士兵康复计划的启示.解放军健康，2009(4):38.
66. MCare Army. http://udm4.com/iPhone/mCare_Army-47921,Accessed2013-01-14.
67. Cusanom D.Care named one of US Army‘s Greatest Inventions‘. http://telecareaware.com/mcare-named-one-of-us-armys-greatest-inventions/, Accessed2013-02-22.
68. Pain Management Task Force Final Report May2010. http://www.apsoc.org.au/PDF/Research/1_US-DoD-Pain-Task-Force-Final-Report-May-2010.pdf, Accessed2010-12-11.
69. A TRICARE Guide Uderstanding Behavioral Health2009November. http://www.humana-military.com/library/pdf/understanding-behavioral-health.pdf,Accessed2012-12-02.
70. Behavioral Health Options For Military Couples. http://www.carolinacounselingservices.com/Tricare%20pays%20for%20Marriage%20Counseling.htm, Accessed2010-10-11.
71.王军，李广文，吕波涛等.美军牙科大队情况简介（上）.人民军医,2012,55(7):606-607.
72.王军，李广文，吕波涛等.美军牙科大队情况简介（下）.人民军医,2012,55(8)：712-7
13.
73.李刚.美军口腔卫生勤务和口腔医疗管理现状.人民军医,2011,54(3):185-187.
74. Active Duty Dental Program. http://tricare.mil/Dental/ADDP.aspx, Accessed2012-11-1
2.
75. TRICARE Dental Program. http://tricare.mil/Dental/TDP.aspx, Accessed2012-11-12.
76. TRICARE Retiree Dental Program.http://tricare.mil/Dental/TRDP.aspx,Accessed2012-11-12.
77. Public Health Service Honors TRICARE Pharmacy Chief. http://www.tricare.com, Accessed2011-08-09.
78. Fodel K. PharmacoEconomic Center. http://www.military-medical-technology.com/mmt-home/15-mmt-2008-volume-12-issue-7/80-pharmacoeconomic-center.html, Accessed2011-07-02.
79. Lieutenant Colonel Stacia Spridgen. TMA-DoD Pharmacoeconomic Center[J/OL]. http://www.military-medical-technology.com/mmt-home/279-mmt-2010-volume-14-issue-7-october/3463-tma-dod-pharmacoeconomic-center.html, Accessed2011-12-12.
80.蒯丽萍，张晓东.美军平时医疗用药政策的启示.军事医学,2012,36(9):704-706.
81. McGinnis TJ. Managing Pharmacy Benefit to Achieve the Quadruple Aim. http://www.usmedicine.com/outlook/managing-pharmacy-benefit-to-achieve-the-quadruple-aim.html, Accessed2011-02-20.
82. Gordon R. Admiral Thomas J. Mcginnis:Managing Pharmacy Benefits Within the Military Health System. http://www.businessofgovernment.org/article/rear-admiral-thomas-j-mcginnis-managing-pharmacy-benefits-within-military-health-system, Accessed2010-06-20.
83. Lukach T. Prescription Drugs and the Active Duty Military. How the MHS is Ensuring a Fit and Ready Force. Mag Force Health Protect Readiness,2010,5（3）:2.
84. Thomas MG Managing the TRICARE Pharmacy Benefit in an Environment of Change. http://usmedicine.com/outlook/managing-the-tricare-pharmacy-benefit-in-an--environment-of-change.html?page=1, Accessed2012-02-03.
85. Jansen DJ, Blakeley Katherine. Military Medical Care: Questions and Answers. http://www.crs.gov.2013-01-30.
86. TRICARE Reduces Pharmacy Home Delivery Co-Pays. http://www.tricare.mil/pressroom/news.aspx?fid=736, Accessed2011-09-07.
87. Briggs Jeremy, Morales Reinaldo. TRICARE Formulary Search Tool. http://www.military-medical-technology.com/mmt-home/363-mmt-2011-volume-15-issue-7-november/4925-tricare-formulary-search-tool.html Accessed2011-12-12.
88.赵晓宇，刁天喜.美军药品保障管理进展.军事医学，2013,36(12):159-161.
89.2010MHS Shakeholders Report. http://www.health.mil/Libraries/Documents_Word_PDF_PPT_etc/2010_MHS_Stakeholders_Report.pdf, Accessed2011-04-17.
90.2011MHS Shakeholders Report. http://www.health.mil/Libraries/Documents_Word_PDF_PPT_etc/2011_MHS_Stakeholders_Report.pdf, Accessed2012-05-17.
91.张奇林.美国医疗保障制度研究.北京:人民出版社，2005.
92. DMLSS Branch of the US Military Lowers Drug Costs by$389Million with MobileComputing. http://www.intermec.se/learning/content_library/case_studies/cs1641.aspx,Accessed2010-02-03.
93. Jeff Tzeng, Christopher J, Hayley H. Cost-Minimization Analysis of the U.S. ArmyAccession Screening and Immunization Program. Mil Med,2012,177(12):1508-1512.
94.许顺雄,郭树森,刘双全.军队医疗保障制度改革现状及发展趋势.中国社会医学杂志,2006,23(1):23-25.
95.刘敏，贺桢，潘景光等.军队医疗保障制度改革的思考.解放军医院管理杂志,2012,19(2):171-172.
96.军队医疗保障制度改革专项论证组.深化军队医疗保障制度改革研究论证报告.总后卫生部，2008.
97.刁天喜;王磊;楼铁柱.2011年度美军卫生勤务进展概述.军事医学,2012,36(1):15-19.
98.楼铁柱.美军―部队全面强健‖理念介绍.人民军医,2012,55(04):302-303.
99.杨永燕.医疗模式在美国获推崇.中国信息界(e医疗),2011(05):19
100.张奇林.美国的医疗卫生费用及其控制.世界经济.2002,(6):53-59.
101.马玉琴，张鹭鹭，杨国士.军队医疗卫生费用拨款状况分析.中国卫生经济.2009,28(2):7-8.
102.赵晓宇,刁天喜.外军卫勤研究系列讲座(53)美军药品经费控制措施简介[J].人民军医,2012,55(05):395-396.
[]张雁灵,刘胡波,刁天喜.美国军队卫勤保障[M].北京：军事医学科学出版社,2010.
[2] The Evaluation of the TRICARE Program: Fiscal Year2011Report to Congress, Accessed2011-02-28.
[3] Military Health System Patient Centered Medical Home Guide.2011-06-01
[4] Tom Philpott. Care Seen Rising Under 'Medical Home' Concept. http://www.military.com, Accessed2012-02-20.
[5]赵晓宇.美军平时医疗保障发展动向.人民军医,2011,54（619）：461-462.
[6] Military Healthcare Professionals Gather For Annual MHS Conference. http://www.usmedicine.com/news/2012/01/31/military-healthcare-professionals-gather-for-annual-mhs-conference.html, Accessed2012-01-31
[7] TRICARE Reduces Pharmacy Home Delivery Co-Pays. http://www.tricare.mil/pressroom/news.aspx?fid=736, Accessed2011-09-07
[8] HEALTH CARE PROVIDER: Providing Health Care Services to Service members and Veterans. Military Medical/CBRN Technology/MMT.2011,15(1).
[3]张良,张琪.对美军医疗保健体制(MHS)改革演化的分析.西南国防医药,2008,18(5):754-755.
[4]刘鹏虎,李明庚.美军医疗保障体制改革.军事经济研究,1994(8):88-90.
[6]张雁灵，刘胡波，刁天喜.美国军队卫勤保障.北京:军事医学科学出版社,2010.
[7]雷二庆,毛玉明,吴乐山.透视美军部队健康全面保护构想军事医学科学院院刊,2004,28(2):168-170.
[11] Steven Schroede. We Can Do Better--Improving the Health of the American People.N Engl J Med,2007(357):1221-1228.
[46]John Holman, Thomas Wickizer. Family Physician Resource Use for Inpatient Care: AComparison between Military Medical Center and Community Hospital. Military Medicine,2006,171(5):365-369.
[48]胡爱平，王明叶.美国的医疗服务与医疗保险[M].北京：高等教育出版社.2010.
[49] Murray JS. Joint Task Force National Capital Region Medical: Integration of Education,Training, and Research. Mil Med,2009,174(5):448-454.
[50] De Lorenzo RA. San Antonio Military Medical Center Integration: A Case Study inOrganizational Leadership Design. Mil Med,2008,173(2):203-209.
[53] Paul B. BRAC revamps system: Changes Affect Delivery Of Healthcare By Military.Modern Healthcare(Modern Healthcare35th Anniversary),2011(8):38.
[54]赵晓宇,刁天喜.美军―圣安东尼奥地区军队卫生系统‖简介.人民军医,2013(1):34-35.
[55] Department Of Defense. Task Force On Military Health System Governance. http://health.mil/MHSGovernanceReport/Enclosure%202%20-%20Volume%201%20revised.pdf,Accessed2011-09-29.
[56]赵晓宇,刁天喜.美军初级医疗保健模式改革.解放军医院管理杂志,2012(10):996-998.
[58] Marshall RC, Doperak M, Milner M, et al. Patient-Centered Medical Home: An Emerging Primary Care Model and the Military Health System. Mil Med,2011,176(11):1253-9.
[64]杨永燕.医疗模式在美国获推崇.中国信息界(e医疗),2011(05):19
[65]赵晓宇.外军卫勤研究系列讲座(42)美军平时医疗保障发展动向.人民军医,2011(6):461-462.
[66]赵晓宇,刁天喜,楼铁柱.美军平时医疗保障概况与改革进展.军事医学,2012(9):707-709.
[71]李培进.美国国防部士兵康复计划的启示.解放军健康，2009(4):38.
77李刚.美军口腔卫生勤务和口腔医疗管理现状.人民军医,2011,54(3):185-187.
[78]王军，李广文，吕波涛等.美军牙科大队情况简介（上）.人民军医,2012,55(7):606-607.
[79]王军，李广文，吕波涛等.美军牙科大队情况简介（下）.人民军医,2012,55(8)：712-713.
[80]李刚.美军口腔卫生勤务和口腔医疗管理现状.人民军医,2011,54(3):185-187.
[81]李广文，王军，张燕.国外航空母舰牙科资源配置及勤务保障研究.2012,14(01):183-184
[88]蒯丽萍，张晓东.美军平时医疗用药政策的启示.军事医学,2012,36(9):704-706.
[90]Gordon R. Admiral Thomas J. Mcginnis:Managing Pharmacy Benefits Within the Milit
[93]Jansen DJ, Blakeley Katherine. Military Medical Care: Questions and Answers. http://www.crs.gov.2013-01-30.
[96]赵晓宇，刁天喜.美军药品保障管理进展.军事医学，2012,36(12):159-161.
[99]张奇林.美国的医疗卫生费用及其控制.世界经济.2002,(6):53-59.
[100]张奇林.论美国的医疗卫生费用控制.美国研究.2002,(01):70-79
[101]张奇林.美国医疗保障制度研究.北京:人民出版社，2005.
[103] Jeff Tzeng, Christopher J, Hayley H. Cost-Minimization Analysis of the U.S. ArmyAccession Screening and Immunization Program. Mil Med,2012,177(12):1508-1512.
[104]许顺雄,郭树森,刘双全.军队医疗保障制度改革现状及发展趋势.中国社会医学杂志,2006,23(1):23-25.
[105]刘敏，贺桢，潘景光等.军队医疗保障制度改革的思考.解放军医院管理杂志,2012,19(2):171-172.
[106]马玉琴;张鹭鹭;杨国士;刘源.军队医疗卫生费用拨款状况分析.中国卫生经济.2009,28(2):7-8.
[107]马守江;张东军队卫生资源配置与合理利用.实用医药杂志.2008,25(12):1528.
[108]刘文清;公斌;时利民.军队医院合理医疗的思考.实用医药杂志,2007,6(6):767-768.
[109]军队医疗保障制度改革专项论证组.深化军队医疗保障制度改革研究论证报告.总后卫生部，2008.
[111]姚伟飚.谈美国DRG管理制度及在我国军队医疗成本核算中的发展.会计之友(上旬).2007(04):37-38.
1.军队医改评估调研组.全军医改评估调研报告.总后卫生部，2009，4
2. Spring B. Saving the American Dream: Improving Health Care and Retirement for Military Service Members and Their Families. http://www.heritage.org/research/reports/2011/11/saving-the-american-dream-improving-health-care-and-retirement-for-military-service-members, Accessed2011-11-17.
3.张良,张琪.对美军医疗保健体制(MHS)改革演化的分析.西南国防医药,2008,18(5):754-75
5.
4.刘鹏虎,李明庚.美军医疗保障体制改革.军事经济研究,1994(8):88-90.
5.张雁灵,刘胡波,刁天喜.美国军队卫勤保障[M].北京:军事医学科学出版社,2010.
6.雷二庆,毛玉明,吴乐山.透视美军部队健康全面保护构想军事医学科学院院刊,2004,28(2):168-170.
7. The Evaluation of the TRICARE Program:Fiscal Year2010Report to Congress.http://www.tricare.mil/tma/downloads/TRICARE201002_28_10v7.pdf, Accessed2010-01-20.
8. Steven Schroede. We Can Do Better--Improving the Health of the American People.N Engl J Med,2007(357):1221-1228.
9. The Evaluation of the TRICARE Program: Fiscal Year2011Report to Congress. http://www.tricare.mil/tma/downloads/TRICARE2011_02_28_11v8.pdf, Accessed2011-03-20.
10. The Evaluation of the TRICARE Program: Fiscal Year2012Report to Congress.http://www.tricare.mil/tma/dhcape/program/downloads/TRICARE2012_02_28v5.pdf, Accessed2012-04-28.
11. TRICARE Prime and TRICARE Prime Remote Handbook.2012. http://www.humana-military.com/.../pdf/prime-remote-handbook.pdf, Accessed2012-09-10.
12. TRICARE Standard Handbook2012. http://www.humana-military.com/library/pdf/standard-handbook.pdf, Accessed2012-08-10.
13. TRICARE Standard Handbook2012. http://www.humana-military.com/library/pdf/standard-handbook.pdf, Accessed2012-08-10.
14. TRICARE Reserve Select. http://www.military.com/benefits/tricare/guard-and-reserve/tricare-reserve-select-overview.html, Accessed2012-11-12
15. TRICARE Choices.2006. http://www.humana-military.com/library/pdf/choices-handbook.pdf, Accessed2012-08-10.
16. TRICARE For Life. http://www.military.com/benefits/tricare/retiree/tricare-for-life.html.Accessed2012-12-02.
17. TRICARE Young Adult. http://www.tricare.mil/tya/.2012-12-20, Accessed2013-12-02.
18. US Family Health Plan. http://www.tricare.mil/Welcome/Plans/USFHP.aspx, Accessed2012-12-09.
19. Department of Defense, Subcommittee of the Defense Health Board,―Report of theTask Force on the Future of Military Health Care,‖December2007, p.92. http://www.dcoe.health.mil/Content/Navigation/Documents/103-06-2-Home-Task_Force_FINAL_REPORT_122007.pdf, Accessed2010-11-10.
20. Prime Enrollment Fees. http://www.tricare.mil/Welcome/Enrollment/TP/EnrollmentFees.aspx, Accessed2011-12-03.
21. RICARE Standard and Extra costs. http://www.tricare.mil/standardcosts/, Accessed2011-12-03.
22. About TMA.http://www.tricare.mil/tma/AboutTMA.aspx,Accessed2010-10-11.
23. TRICARE Management Activity Organization chart. http://search.yahoo.com/r/_ylt=A0oGdW6fOVlRs00Ay7tXNyoA;_ylu=X3oDMTE1azMydnNrBHNlYwNzcgRwb3MDNQRjb2xvA3NrMQR2dGlkA1ZJUDEzMV8xNjQ-/SIG=12vo0h68a/EXP=1364830751/**http%3a//www.documbase.com/TRICARE-Management-Activity-Organization-Chart.pdf, Accessed2011-11-07.
24. About CAP. http://www.cap.mil/AboutCAP/AboutCAP.aspx, Accessed2010-10-07.
25. About DoD Patient Safety Program. http://www.health.mil/dodpatientsafety/AboutUs.aspx, Accessed2010-11-02. http://www.tricare.mil/fraud/, Accessed2010-09-02
26. Mission Statement. http://www.tricare.mil/tma/MMSO/, Accessed2011-08-12.
27. TMA Privacy and Civil Liberties Office. http://www.tricare.mil/tma/privacy/,Accessed2012-02-12.
28. TRICARE, SAIC Report Loss Of Data On4.9Million beneficiaries. http://search.yahoo.com/r/_ylt=A0oGdUsAPllRhyIA9UNXNyoA;_ylu=X3oDMTE1a3Z1aDF2BHNlYwNzcgRwb3MDNwRjb2xvA3NrMQR2dGlkA1ZJUDEzMV8xNjQ-/SIG=11ng52okj/EXP=1364831872/**http%3a//www.phiprivacy.net/%3fp=7854, Accessed2011-11-07.
29. Senior Enlisted Advisor's Mission. http://www.tricare.mil/tma/aboutTMA/sea/default.aspx, Accessed2011-11-10.
30. Defense Health Cost Assessment and Program Evaluation (DHCAPE). http://www.tricare.mil/tma/dhcape/, Accessed2011-12-13.
31. TRICARE Service Centers. http://www.tricare.mil/tma/TSC.aspx,Accessed2012-12-10.
32. Acquisition Management and Support (AM&S) Directorate. http://www.tricare.mil/tma/AMS/default.aspx, Accessed2012-12-10.
33. Acquisition Management and Support Directorate Chart. http://search.yahoo.com/r/_ylt=A0oGdW6fOVlRs00Ay7tXNyoA;_ylu=X3oDMTE1azMydnNrBHNlYwNzcgRwb3MDNQRjb2xvA3NrMQR2dGlkA1ZJUDEzMV8xNjQ-/SIG=12vo0h68a/EXP=1364830751/**http%3a//www.documbase.com/TRICARE-Management-Activity-Organization-Chart.pdf, Accessed2011-11-07.
34. http://dhims.health.mil/, Accessed2010-12-23.
35. http://www.health.mil/MHSCIO/programs_products/DHSS.aspx, Accessed2010-12-23.
36. Defense Health Services Systems (DHSS) Chart. http://search.yahoo.com/r/_ylt=A0oGdW6fOVlRs00Ay7tXNyoA;_ylu=X3oDMTE1azMydnNrBHNlYwNzcgRwb3MDNQRjb2xvA3NrMQR2dGlkA1ZJUDEzMV8xNjQ-/SIG=12vo0h68a/EXP=1364830751/**http%3a//www.documbase.com/TRICARE-Management-Activity-Organization-Chart.pdf,Accessed2011-11-07.
37. Office of General Counsel Chart. http://search.yahoo.com/r/_ylt=A0oGdW6fOVlRs00Ay7tXNyoA;_ylu=X3oDMTE1azMydnNrBHNlYwNzcgRwb3MDNQRjb2xvA3NrMQR2dGlkA1ZJUDEzMV8xNjQ-/SIG=12vo0h68a/EXP=1364830751/**http%3a//www.documbase.com/TRICARE-Management-Activity-Organization-Chart.pdf, Accessed2011-11-07.
38. TRICARE North Region.http://www.tricare.mil/tma/AboutTMA.aspx,Accessed2011-12-0
7.
39. Office of Deputy Director, TRICARE Regional Operations TRICARE Regional Office–North. http://search.yahoo.com/r/_ylt=A0oGdW6fOVlRs00Ay7tXNyoA;_ylu=X3oDMTE1azMydnNrBHNlYwNzcgRwb3MDNQRjb2xvA3NrMQR2dGlkA1ZJUDEzMV8xNjQ-/SIG=12vo0h68a/EXP=1364830751/**http%3a//www.documbase.com/TRICARE-Management-Activity-Organization-Chart.pdf,, Accessed2011-11-07.
40. Access to care about army medicine. http://www.medicine.army.mil/hc/medfacilities/CommandControl.htm, Accessed2011-11-07.
41. John Holman, Thomas Wickizer. Family Physician Resource Use for Inpatient Care: AComparison between Military Medical Center and Community Hospital. Military Medicine,2006,171(5):365-369.
42. Careers&Jobs. http://chaplian.goarmy.com/JobCatDetail.do?id=9, Accessed2012-08-06.
43.胡爱平，王明叶.美国的医疗服务与医疗保险.北京：高等教育出版社.2010.
44. Murray JS. Joint Task Force National Capital Region Medical: Integration of Education, Training, and Research. Mil Med,2009,174(5):448-454.
45. De Lorenzo RA. San Antonio Military Medical Center Integration: A Case Study inOrganizational Leadership Design. Mil Med,2008,173(2):203-209.
46. Joint Task Force National Capital Region Medical. http://www.boozallen.com/media/file/JTF-National-Capital-Regional-Medical-cs.pdf, Accessed2013-03-09.
47. Joint Task Force National Capital Region/Medical. http://en.wikipedia.org/wiki/Joint_Task_Force_National_Capital_Region/Medical, Accessed2013-02-09.
48. Paul B. BRAC revamps system: Changes Affect Delivery Of Healthcare By Military.Modern Healthcare(Modern Healthcare35th Anniversary),2011(8):38.
49.赵晓宇,刁天喜.美军―圣安东尼奥地区军队卫生系统‖简介.人民军医,2013,56(1):34-35.
50. Department Of Defense. Task Force On Military Health System Governance. http://health.mil/MHSGovernanceReport/Enclosure%202%20-%20Volume%201%20revised.pdf, Accessed2011-09-29.
51.赵晓宇,刁天喜.美军初级医疗保健模式改革.解放军医院管理杂志,,2012,19(10):996-998.
52. Military Healthcare Professionals Gather For Annual MHS Conference. http://www.usmedicine.com/news/2012/01/31/military-healthcare-professionals-gather-for-annual-mhs-conference.html, Accessed2012-01-31.
53. Philpott T. Care Seen Rising Under 'Medical Home' Concept. http://www.military.com/features/0,15240,226300,00.html, Accessed2012-02-20.
54. Military Health System Patient Centered Medical Home Guide2011-06-01. http://www.tricare.mil/tma/ocmo/download/MHSPCMHGuide.pdf, Accessed2011-12-01.
55. Marshall RC, Doperak M, Milner M, et al. Patient-Centered Medical Home: An Emerging Primary Care Model and the Military Health System. Mil Med,2011,176(11):1253-1259.
56. Operation Order (OPORD)11-20, Army Patient Centered Medical Home. http://www.tricare.mil/tma/ocmo/download/MHSPCMHGuide. pdf, Accessed2011-11-01.
57. DoD and VA pursue PCMH model. http://www.govhealthit.com/news/dod-and-va-pursue-pcmh-model, Accessed2012-01-03.
58. Policy Memorandum Implementation of the Patient Centered Medical HomeModel ofPrimary Care in MTFs. http://www.usafp.org/PCMH-Files/DoD-Files/PCMH-Policy-Memo--signed-18-Sep-09.pdf. Accessed2009-09-18.
59.赵晓宇.外军卫勤研究系列讲座(42)美军平时医疗保障发展动向.人民军医,2011,54(6):461-462.
60.赵晓宇,刁天喜,楼铁柱.美军平时医疗保障概况与改革进展.军事医学,2012,36(9):707-7
09.
61. Operation Live Well Focuses on Healthy Living. http://www.health.mil/News_And_Multimedia/News/detail/13-01-14/Operation_Live_Well_Focuses_on_Healthy_Living.aspx, Accessed2013-01-14.
62. TRICARE Expands Retail Pharmacy Vaccine Program. http://tricare.mil/Welcome/MediaCenter/News/Archives/51_ExpandedVaccineProgram.aspx?NavContext={68EF1CC1-D05F-485B-883A-E24160FE942A}, Accessed2011-08-22.
63. About WTC.http://wtc.armylive.dodlive.mil/about-wtc/, Accessed2011-08-22.
64.走进美军坎贝尔堡士兵康复中心. http://article.yeeyan.org/view/95021/124657,Accessed2011-08-22.
65.李培进.美国国防部士兵康复计划的启示.解放军健康，2009(4):38.
66. MCare Army. http://udm4.com/iPhone/mCare_Army-47921,Accessed2013-01-14.
67. Cusanom D.Care named one of US Army‘s Greatest Inventions‘. http://telecareaware.com/mcare-named-one-of-us-armys-greatest-inventions/, Accessed2013-02-22.
68. Pain Management Task Force Final Report May2010. http://www.apsoc.org.au/PDF/Research/1_US-DoD-Pain-Task-Force-Final-Report-May-2010.pdf, Accessed2010-12-11.
69. A TRICARE Guide Uderstanding Behavioral Health2009November. http://www.humana-military.com/library/pdf/understanding-behavioral-health.pdf,Accessed2012-12-02.
70. Behavioral Health Options For Military Couples. http://www.carolinacounselingservices.com/Tricare%20pays%20for%20Marriage%20Counseling.htm, Accessed2010-10-11.
71.王军，李广文，吕波涛等.美军牙科大队情况简介（上）.人民军医,2012,55(7):606-607.
72.王军，李广文，吕波涛等.美军牙科大队情况简介（下）.人民军医,2012,55(8)：712-7
13.
73.李刚.美军口腔卫生勤务和口腔医疗管理现状.人民军医,2011,54(3):185-187.
74. Active Duty Dental Program. http://tricare.mil/Dental/ADDP.aspx, Accessed2012-11-1
2.
75. TRICARE Dental Program. http://tricare.mil/Dental/TDP.aspx, Accessed2012-11-12.
76. TRICARE Retiree Dental Program.http://tricare.mil/Dental/TRDP.aspx,Accessed2012-11-12.
77. Public Health Service Honors TRICARE Pharmacy Chief. http://www.tricare.com, Accessed2011-08-09.
78. Fodel K. PharmacoEconomic Center. http://www.military-medical-technology.com/mmt-home/15-mmt-2008-volume-12-issue-7/80-pharmacoeconomic-center.html, Accessed2011-07-02.
79. Lieutenant Colonel Stacia Spridgen. TMA-DoD Pharmacoeconomic Center[J/OL]. http://www.military-medical-technology.com/mmt-home/279-mmt-2010-volume-14-issue-7-october/3463-tma-dod-pharmacoeconomic-center.html, Accessed2011-12-12.
80.蒯丽萍，张晓东.美军平时医疗用药政策的启示.军事医学,2012,36(9):704-706.
81. McGinnis TJ. Managing Pharmacy Benefit to Achieve the Quadruple Aim. http://www.usmedicine.com/outlook/managing-pharmacy-benefit-to-achieve-the-quadruple-aim.html, Accessed2011-02-20.
82. Gordon R. Admiral Thomas J. Mcginnis:Managing Pharmacy Benefits Within the Military Health System. http://www.businessofgovernment.org/article/rear-admiral-thomas-j-mcginnis-managing-pharmacy-benefits-within-military-health-system, Accessed2010-06-20.
83. Lukach T. Prescription Drugs and the Active Duty Military. How the MHS is Ensuring a Fit and Ready Force. Mag Force Health Protect Readiness,2010,5（3）:2.
84. Thomas MG Managing the TRICARE Pharmacy Benefit in an Environment of Change. http://usmedicine.com/outlook/managing-the-tricare-pharmacy-benefit-in-an--environment-of-change.html?page=1, Accessed2012-02-03.
85. Jansen DJ, Blakeley Katherine. Military Medical Care: Questions and Answers. http://www.crs.gov.2013-01-30.
86. TRICARE Reduces Pharmacy Home Delivery Co-Pays. http://www.tricare.mil/pressroom/news.aspx?fid=736, Accessed2011-09-07.
87. Briggs Jeremy, Morales Reinaldo. TRICARE Formulary Search Tool. http://www.military-medical-technology.com/mmt-home/363-mmt-2011-volume-15-issue-7-november/4925-tricare-formulary-search-tool.html Accessed2011-12-12.
88.赵晓宇，刁天喜.美军药品保障管理进展.军事医学，2013,36(12):159-161.
89.2010MHS Shakeholders Report. http://www.health.mil/Libraries/Documents_Word_PDF_PPT_etc/2010_MHS_Stakeholders_Report.pdf, Accessed2011-04-17.
90.2011MHS Shakeholders Report. http://www.health.mil/Libraries/Documents_Word_PDF_PPT_etc/2011_MHS_Stakeholders_Report.pdf, Accessed2012-05-17.
91.张奇林.美国医疗保障制度研究.北京:人民出版社，2005.
92. DMLSS Branch of the US Military Lowers Drug Costs by$389Million with MobileComputing. http://www.intermec.se/learning/content_library/case_studies/cs1641.aspx,Accessed2010-02-03.
93. Jeff Tzeng, Christopher J, Hayley H. Cost-Minimization Analysis of the U.S. ArmyAccession Screening and Immunization Program. Mil Med,2012,177(12):1508-1512.
94.许顺雄,郭树森,刘双全.军队医疗保障制度改革现状及发展趋势.中国社会医学杂志,2006,23(1):23-25.
95.刘敏，贺桢，潘景光等.军队医疗保障制度改革的思考.解放军医院管理杂志,2012,19(2):171-172.
96.军队医疗保障制度改革专项论证组.深化军队医疗保障制度改革研究论证报告.总后卫生部，2008.
97.刁天喜;王磊;楼铁柱.2011年度美军卫生勤务进展概述.军事医学,2012,36(1):15-19.
98.楼铁柱.美军―部队全面强健‖理念介绍.人民军医,2012,55(04):302-303.
99.杨永燕.医疗模式在美国获推崇.中国信息界(e医疗),2011(05):19
100.张奇林.美国的医疗卫生费用及其控制.世界经济.2002,(6):53-59.
101.马玉琴，张鹭鹭，杨国士.军队医疗卫生费用拨款状况分析.中国卫生经济.2009,28(2):7-8.
102.赵晓宇,刁天喜.外军卫勤研究系列讲座(53)美军药品经费控制措施简介[J].人民军医,2012,55(05):395-396.
[]张雁灵,刘胡波,刁天喜.美国军队卫勤保障[M].北京：军事医学科学出版社,2010.
[2] The Evaluation of the TRICARE Program: Fiscal Year2011Report to Congress, Accessed2011-02-28.
[3] Military Health System Patient Centered Medical Home Guide.2011-06-01
[4] Tom Philpott. Care Seen Rising Under 'Medical Home' Concept. http://www.military.com, Accessed2012-02-20.
[5]赵晓宇.美军平时医疗保障发展动向.人民军医,2011,54（619）：461-462.
[6] Military Healthcare Professionals Gather For Annual MHS Conference. http://www.usmedicine.com/news/2012/01/31/military-healthcare-professionals-gather-for-annual-mhs-conference.html, Accessed2012-01-31
[7] TRICARE Reduces Pharmacy Home Delivery Co-Pays. http://www.tricare.mil/pressroom/news.aspx?fid=736, Accessed2011-09-07
[8] HEALTH CARE PROVIDER: Providing Health Care Services to Service members and Veterans. Military Medical/CBRN Technology/MMT.2011,15(1).