Analyzing the US Military Health System Reform and its Evaluation from the Perspective of Türkiye within Frame of International Security

Yıl 2025, Cilt: 21 Sayı: 50, 73 - 102, 23.04.2025

Oğuzhan Özmen , Pelin Özmen , Uğur Tarık Özkut

https://doi.org/10.17752/guvenlikstrtj.1525849

Öz

This study aims to examine the timing and rationale behind the need to reform the United States (US) Military Health System (MHS) and the ongoing reform initiatives and to assess the implications for Türkiye's defense and security. The MHS has been evaluated conceptually and functionally using information from US Congressional reports, secondary sources, data on transformation and reform efforts, expert opinions, and publicly available information. This study has been conducted as qualitative research employing inductive coding to extract themes related to health management, integrated health services, innovation, and combat readiness. A key study finding shows that there will be an increasing demand for small, swift, mobile, and highly skilled health units and personnel within military health organizations as the complexity of the combat environment escalates. Furthermore, it appears that the humanitarian capabilities of military health in international politics can significantly influence the strategic maneuverability of policy decisions. The timing of the US reform is interpreted as indicative of major regional conflicts, reinforcing the need for Türkiye to reform its national military health system in alignment with its defense industry by 2030 the latest. Key reform areas identified for military health systems include innovation, operational medicine, reorganization, and integrated record systems.

Anahtar Kelimeler

Military Health System, Innovation in Military Health, Combat Effectiveness, US Army, Turkish Military Healthcare System

ABD Askeri Sağlık Sistemi Reformunun İncelenmesi ve Uluslararası Güvenlik Çerçevesinde Türkiye Açısından Değerlendirilmesi

Öz

Bu çalışmanın amacı; ABD askeri sağlık sistemindeki (ABD-ASS) reform ihtiyacının zamanlaması, nedenleri ve reform faaliyetlerinin analiz edilmesi, buradan elde edilen sonuçların, Türkiye’nin savunma ve güvenliği açısından değerlendirilmesidir. ASS, ulusal kongre raporları, ikincil kaynaklar, dönüşüm ve reformla ilgili veriler, uzman görüşleri ve açık kaynaklardan elde edilen bilgilerle kavramsal ve fonksiyonel olarak değerlendirilmiştir. Çalışma sağlık yönetimi, entegre sağlık hizmetleri, inovasyon ve muharebe hazırlığı temalarının elde edilmesine yönelik, tümevarımsal kodlamanın kullanıldığı, nitel bir araştırma olarak planlanmış ve gerçekleştirilmiştir. Çalışmanın temel bulgusu; muharebe ortamında karmaşıklık arttıkça askeri sağlık organizasyonunda küçük, hızlı, mobil ve deneyim sahibi sağlık birlik ve personeline ihtiyacın artacağıdır. Ayrıca askeri sağlığın uluslararası siyasetteki insancıl gücünün de politikaya hareket sahası kazandırmakta etkili olacağı görülmektedir. ABD’nin reform zamanlamasının, büyük bölgesel savaşların emaresi olarak değerlendirilebileceği ve Türkiye’nin savunma sanayii ile paralel olarak milli askeri sağlık sistemini de en geç 2030 yılına kadar reforme etmesi gerektiği sonucuna varılmıştır. İnovasyon, operasyonel tıp, reorganizasyon ve entegre kayıt sistemleri askeri sağlık sistemlerinin odaklanması gereken, temel reform konuları olarak tespit edilmiştir.

Anahtar Kelimeler

Askeri Sağlık Sistemi, Askeri Sağlıkta İnovasyon, Muharebe Etkinliği, ABD Ordusu, Türk Askeri Sağlık Sistemi

Kaynakça

• AMONSON Kyle ve EGLI Dane (2023). “The Ambitious Dragon; Beijing’s Calculus for Invading Taiwan by 2030”, Journal of Indo-Pacific Affairs, 6:3, 38-54.
• ATEŞ Barış (ed.) (2023). Türkiye’de Askeri Yenilik: Soğuk Savaş Sonrası Dönem Üzerine Bir İnceleme, Vakıfbank Kültür Yayınları, İstanbul.
• BMCC. (2024). Bildiri Özetleri Kitabı. 26’ncı Balkan Askeri Tıp Kongresi, Selanik.
• Congressional Budget Office. (2017). Approaches to Changing Military Health Care. Congress Research Service.
• Congress Research Service. (2013,2014,2018,2021). Military Medical Care: Frequently Asked. Congressional Research Service.
• Congress Research Service. (2019). Military Health System Reform. Congress Research Service. DHA, (2023). Evaluation of the Tricare Program: FY 2023 Report of Congress.
• JACKEL Aleksander (2023). Combining Efforts in Medical Support for Ukraine, Europe Military Medicine Services.
• KURT Veysel ve YİĞİT Murat (2024). Türk Savunma Sanayiinin Gelişimi “Siyasal ve Bürokratik Arka Plan, Türkiye Araştırmaları Vakfı, İstanbul.
• MEYDAN Cem H. (2015). “Dünya Ordularında Yeniden Yapılanmanın Kaynakları Üzerine Bir İnceleme”, Güvenlik Stratejileri Dergisi, 11:21, 1-39.
• ÖZMEN Oğuzhan ve ÖZMEN Pelin (2023). “A Scientific Evaluation for Military Medical Services in the Russia-Ukraine War”, Iranian Journal of War and Public Health, 15:4, 395-403.
• SARMA Karthik (2023). “Integrating Battlefield Documentation into Virtual Reality Medical Simulation Training: Virtual Battlefield Assisted Trauma Distributed Observation Kit (BATDOK)”, Military Medicine, 188(Suppl), 110-115.
• SKTD. (2024). 29’uncu Silahlı Kuvvetler Tıp Konferansı Bildiri Özetleri Kitabı, Yunanistan Silahlı Kuvvetler Tıp Derneği, Selanik, 25-29.
• SIEGEL Rebecca L. GIAQUINTO Angela N. ve CEMAL Ahmedin (2024). “Cancer Statistics, 2024”, A Cancer Journal for Clinicians, 74:1, 12-49.
• “About the Defense Health Agency”, DHA, https://dha.mil/About-DHA, 2024, erişim 25.06.2024.
• “About the Military Health System”, MHS, https://health.mil/About-MHS erişim 27.02.2025.
• “All Jobs”, US Army, https://www.goarmy.com/careers-and-jobs/browse-jobs, erişim 18.10.2024.
• “Army Medical Logistics Command. Us Medical Material Agency”, USAMMA, 2018, https://www.amlc. army.mil/USAMMA/, erişim 20.06.2024.
• “Army Jobs” US Army,, https://www.goarmy.com/careers-and-jobs/browse-career-and-job-categories/ medical-and-emergency/combat-medic-specialist.html, erişim 15.03.2024.
• “Army Medical (AMEDD)”, US Army, https://www.goarmy.com/careers-and-jobs/specialty-careers/medical, erişim 25.12.2024.
• “Medical Training & Residency”, GoArmy, https://www.goarmy.com/careers-and-jobs/specialty-careers/ medical/residency-locations, 2024, erişim 15.03.2024.
• “Medicine and the Military”, https://www.medicineandthemilitary.com/career-and-lifestyle/militarymedical- facilities-map/, erişim 11.06.2024.
• “Military Health System Reform”, National Military Family Assosiation, 2020, https://www.militaryfamily. org/wp-content/uploads/Miltary-Health-System-Reform.pdf, erişim 11.08.2024.
• “Operations, Plans, and Training”, DHA, https://dha.mil/About-DHA/Organizational-Structure/Operations- Plans-and-Training erişim 27.02.2025.
• “SIPRI Military Expenditure Database”, Stockholm International Peace Research Institute, https://www. sipri.org/databases/milex, erişim 13.12.2024.
• “Türkiye Defense Market Overview”, Reportlinker.com, https://www.reportlinker.com/marketreport/ Defense/666607/Defense?term=defense%20research&matchtype=b&loc_interest=&loc_ physical=9198902&utm_group=standard&utm_term=defense%20research&utm_ campaign=ppc&utm_source=google_ads&utm_medium=paid_ads&utm_content=, erişim 21.01.2025.
• “Yakın Geleceğin Savaşlarında Ahlâk Kuralları”, SunSavunma, https://sunsavunma.net/yakin-geleceginsavaslarinda-ahlak-kurallari/, erişim 12.05.2024.
• “Yeni Bir Dünya Savaşının Emareleri Ortaya Çıkmış Durumda”, Tesnim Haber Ajansı, https:// www.tasnimnews.com/tr/news/2024/04/29/3076739/borrell-yeni-bir-d%C3%BCnyasava% C5%9F%C4%B1n%C4%B1n-emareleri-ortaya-%C3%A7%C4%B1km%C4%B1%C5%9Fdurumda, erişim 20.02.2025.
• AKER Janet A. (2022). “How Military Medicine Is Preparing for the Next Conflict”, U.S. Department of Defense, Haziran 2022, https://www.defense.gov/News/News-Stories/Article/Article/3062283/ military-medicine-is-preparing-for-the-next-conflict/, erişim 04.02.2025.
• ANDRUS John (2024). “Leading Through MHS Change”, MHS Conference 2024, https://mhsrs.health.mil/ Sites/mhsrs2024/submissions/SitePages/Accepted-Abstracts.aspx, erişim 16.06.2024.
• BIGGERSTAFF Sean (2024). “Military Medical Research in the DHA: An Overview”, MHS Conference 2024, https://mhsrs.health.mil/Sites/mhsrs2024/submissions/SitePages/Accepted-Abstracts.aspx, erişim 19.06.2024.
• BITTERMANN Jeff (2024). “Seize The Initiative”, MHS Conference 2024, https://mhsrs.health.mil/Sites/ mhsrs2024/submissions/SitePages/Accepted-Abstracts.aspx, erişim 14.07.2024.
• CADELL Cate (2023). “China’s nuclear arsenal on track to double by 2030, Pentagon reports”, The Washington Post, https://www.washingtonpost.com/national-security/2023/10/19/china-militarypower- report-nuclear/, erişim 15.07.2024.
• CATALANO John (2024). “Operational Medicine. Where The Army is Going and What We’ve Learned from Project Convergence Capstone 4”, MHS Conference 2024, https://mhsrs.health.mil/Sites/mhsrs2024/ submissions/SitePages/Accepted-Abstracts.aspx, erişim 16.06.2024
• DIEHL Glendon B. (2024). “The Strategic Context of Global He alth Engagement”, MHS Conference 2024, https://mhsrs.health.mil/Sites/mhsrs2024/submissions/SitePages/Accepted-Abstracts.aspx, erişim 16.06.2024.
• DIEHL Glendon ve WORLTON Tamara (2024). “Global Health Engagement: Context, Collaboration, and Collegiality”, MHS Conference 2024, https://mhsrs.health.mil/Sites/mhsrs2024/submissions/ SitePages/Accepted-Abstracts.aspx, erişim 15.06.2024
• EGTS Alesha (2024). “Digital Front Door”, MHS Conference 2024, https://mhsrs.health.mil/Sites/mhsrs2024/ submissions/SitePages/Accepted-Abstracts.aspx, erişim 18.06.2024
• ELSTER Eric (2024). “Military Medical Education: Century 21 and Beyond”. MHS Conference 2024, Portland: MHS. https://alfresco.axiom-rm.com/share/s/MyQPUfhJTDGODniLsgHoWQ, erişim 19.06.2024.
• FREEMAN Jeff (2024). “National Center for Disaster Medicine and Public Health”, MHS Conference 2024, https://mhsrs.health.mil/Sites/mhsrs2024/submissions/SitePages/Accepted-Abstracts.aspx, erişim 19.06.2024.
• FRIENDLY Sean (2024). “Biosurveillance: Current Successes and Future Opportunities”, MHS Conference 2024, https://www.mhsconference.com/event/ba00b22b-e681-458e-908f-ef5bdde8315e/ websitePage:56367d01-5f6a-4fc8-aa66-812d2011d3f7, erişim 20.06.2024.
• GAO (2023). Defense Health Care, GAO Report. https://www.gao.gov/assets/d23105441.pdf, erişim 18.10.2024.
• HAMMER Robbie (2024). “Military Health System Conference a ‘Resounding Success’”, 2024 Military Health System Conference, https://www.health.mil/News/Dvids-Articles/2024/05/07/news470529 erişim 11.08.2024.
• HERMAN Dawn (2024). “Right Talent, Right Place”, MHS Conference 2024. https://www.mhsconference. com/event/ba00b22b-e681-458e-908f-ef5bdde8315e/websitePage:56367d01-5f6a-4fc8-aa66- 812d2011d3f7 erişim 11.07.2024.
• HONRADA Gabriel (2024). “China’s Global Military Base Strategy Taking Shape”. AsiaTimes, https://asiatimes.com/2024/06/chinas-global-military-base-strategy-taking-shape/, erişim 14.06.2024.
• HOSEA Lonnie (2024). “MHS Governance”, MHS Conference 2024, https://mhsrs.health.mil/Sites/ mhsrs2024/submissions/SitePages/Accepted-Abstracts.aspx, erişim 22.07.2024.
• JANSEN Don J. ve BLAKELEY Katherine. “Military Medical Care: Questions and Answers”, CRS Report for Congress, January 2014, https://sgp.fas.org/crs/misc/RL33537.pdf, erişim 10.03.2025. J
• OHN Sarah K. CARRINGTON-FAIR Dylan J. GOLDBERG Matthew S. HILDRETH Laura LINDLY A. Jamie M. LUAN W. Patrick ve MINNECI Madeline (2019). “Feasibility Study for the Consolidation of Military Medical Education and Training Organizations, Functions, and Activities”, Institute For Defence Analayses, https://apps.dtic.mil/sti/tr/pdf/AD1098421.pdf, erişim 25.02.2025.
• KAISSI Amer (2024). “Leading in Difficult Times”, MHS Conference 2024, Nisan 2024, https://custom.cvent. com/6C73CFFFCC664B4D8DAF9D6668542C41/files/f52d10d92cfd430397c68cc9723a7d8b.pdf erişim 11.06.2024.
• KENNARD Matt (2023). Revealed: America’s Secret Military Deployment on British Cyprus, Declassified UK, https://www.declassifieduk.org/revealed-americas-secret-military-deployment-on-britishcyprus/, erişim 14.12.2024.
• KORTEPETER Mark G. ve BROSCH Laura R. (2024). „Leveraging Innovation at USU to Support Medical Research for the Warfighter”, MHS Conference 2024, https://mhsrs.health.mil/Sites/mhsrs2024/ submissions/SitePages/Accepted-Abstracts.aspx, erişim 14.06.2024.
• MASSICOT Dara (2024). “Russian Military Reconstitution: 2030 Pathways and Prospects”. Carnegie Endowment for International Peace, https://carnegieendowment.org/research/2024/09/russianmilitary- reconstitution-2030-pathways-and-prospects?lang=en, erişim 11.07.2024.
• MHS (2024) https://www.mhsconference.com/event erişim 25.06.2024. MHS (2024). Assistant Secretary of Defense for Health Affairs, https://www.health.mil/About-MHS/ OASDHA/ASDHA, erişim 23.03.2025.
• MHS (2025). About the Military Health System, https://health.mil/About-MHS erişim 27.02.2025.
• MHS Genesis-T. (2024). Joint Operational Medicine Information Systems MHS Genesis Theater. health.mil: https://www.health.mil/Reference-Center/Fact-Sheets/2023/06/07/MHS-GENESIS-Theater-Fact- Sheet erişim 11.07.2024.
• MHS Genesis. (2024). MHS GENESIS: The Electronic Health Record. health.mil: https://www.health.mil/MilitaryHealth-Topics/Technology/MHS-GENESIS erişim 11.07.2024.
• MINCHER Robyn (2024). “Military Health System Stabilization: Rebuilding Health Care Access Is Critical to Patient’s Well-Being”, U.S. Department of Defence, https://www.defense.gov/News/News-Stories/Article/Article/3652092/, erişim 25.07.2024.
• MULLEN Seileen (2024). “Military Medicine in the Age of AI”, MHS Conference 2024, Nisan 2024, https://custom.cvent.com/6C73CFFFCC664B4D8DAF9D6668542C41/ files/8008fb04aca9402488f2fe945d34dbbc.pdf, erişim 17.06.2024.
• OpMed CDP. (2024). Joint Operational Medicine Information Systems Operational Medicine Care Delivery Platform (OpMed CDP). health.mil: https://www.health.mil/Reference-Center/Fact-Sheets/2023/09/01/OpMed-CDP-Fact-Sheet erişim 11.07.2024.
• PAUL Cordts R. vd. (2024). “Genomic Medicine, Pharmacogenomics and Data Security for Precision Care”, MHS Conference 2024, https://mhsrs.health.mil/Sites/mhsrs2024/submissions/SitePages/Accepted-Abstracts.aspx erişim 19.06.2024.
• Resmî Gazete. (2024). https://www.resmigazete.gov.tr/eskiler/2017/12/20171202-3.htm, erişim 21.08.2024.
• RIGGS Leslie ve MARTINEZ Joshua (2024). “Blood Supply Solutions in a Challenging Environment”, MHS Conference 2024, https://alfresco.axiom-rm.com/share/s/rgKjl4fgTYiBtVmJsw93jg, erişim 19.06.2024.
• SHRIVER Craig D. ve BEARHS Oliver H. (2024). “Biden Cancer Moonshot & USU Cancer Research”, MHS Conference 2024, https://custom.cvent.com/6C73CFFFCC664B4D8DAF9D6668542C41/files/5dbaacd649eb4de29eb5d0fa64102d93.pdf,erişim 15.06.2024.
• SMART John (2024). “DHP Audit Roadmap” MHS Conference 2024, https://www.mhsconference.com/event/ ba00b22b-e681-458e-908f-ef5bdde8315e/websitePage:56367d01-5f6a-4fc8-aa66-812d2011d3f7 erişim 18.06.2024.
• STEVENSON Mark J. ve WEBSTER Shana K. (2024). TRICARE: T-5 Update/ Transition/Innovation. MHS Conference, https://mhsrs.health.mil/Sites/mhsrs2024/submissions/SitePages/Accepted-Abstracts. aspx, erişim 11.06.2024.
• TAMMEN John (2021). NATO’nun Savaş Yeteneğini Geliştirme Kavramı: Savaşın Değişen Karakterini Önceden Görmek, NATO Review. https://www.nato.int/docu/review/tr/articles/2021/07/09/natonunsavas- yetenegini-gelistirme-kavrami-savasin-degisen-karakterini-oenceden-goermek/index.html, erişim 17.06.2024.
• TINSTON Bill vd. (2024). “Building on the Federal Electronic Health Record (EHR) Success”, MHS Conference 2024, https://custom.cvent.com/6C73CFFFCC664B4D8DAF9D6668542C41/files/746353aaeec94c6eb0adf4e136fb551f.pdf, erişim 16.07.2024.
• USPHS001 (2024). USPHS. https://www.usphs.gov/, erişim 30.11.2024.
• USUHS001 (2017). https://www.usuhs.edu/centers, erişim 27.02.2025.
• USUHS002 (2023). https://medschool.usuhs.edu/about, erişim 13.11.2024.
• USUHS003 (2024). https://www.usuhs.edu/ao/brigade/military-benefits, erişim 12.07.2024.
• WALDWYN Tom. “Turkiye’s Defence Industry Charts a Course for European Growth”, International Institute for Strategic Studies, 2025, https://www.iiss.org/online-analysis/military-balance/2025/01/ turkiyes-defence-industry-charts-a-course-for-european-growth/, erişim 23.01.2025.
• WALKER Bob (2024). “Military Medicine in the Age of AI: DHA Perspective”, MHS Conference 2024, h t t p s : / / c u s t o m . c v e n t . c o m / 6 C 7 3 C F F F C C 6 6 4 B 4 D 8 D A F 9 D 6 6 6 8 5 4 2 C 4 1 / files/8008fb04aca9402488f2fe945d34dbbc.pdf, erişim 20.06.2024.
• WILLIAMS Scott vd. (2024). “Addressing Moral Injury”, MHS Conference 2024, https://alfresco.axiom-rm.com/share/s/HHaLIiDRSA-kaIWjI9x-Dw, erişim 20.06.2024.
• WOODSON Jonathan (2024). “Transformation of Health Professions Education and Research Using AI”, https://custom.cvent.com/6C73CFFFCC664B4D8DAF9D6668542C41/ files/8008fb04aca9402488f2fe945d34dbbc.pdf, erişim 18.06.2024.