https://crsreports.congress.gov
Updated June 10, 2021
Defense Health Primer: U.S. Coast Guard Health Services
Established in 1790, the U.S. Coast Guard (USCG) is a
military service in the Department of Homeland Security
(DHS) and a branch of the armed forces of the United
States. The role of USCG is to provide security, maritime
safety, and environmental stewardship on the high seas and
in the ports, inland waterways, and maritime economic
zones of the United States. To support these tasks, 14
U.S.C. §504 authorizes USCG to administer a Health
Services program to sustain the medical readiness of
approximately 47,000 active duty and reserve
servicemembers of the Coast Guard. The USCG program
also collaborates with the Military Health System (MHS) of
the Department of Defense (DOD) to offer health care
services to 9.6 million beneficiaries eligible for TRICARE.
Mission
The USCG Health, Safety, and Work-Life (HSWL)
Directorate (CG-11) administers the USCG Health Services
program; it
provides health care to active duty and reserve
servicemembers supporting USCG missions;
“ensure[s] the medical and dental readiness” of
servicemembers for “world-wide deployment;” and
ensures the availability of quality, cost-effective health
care for all eligible Coast Guard beneficiaries (i.e.,
active and reserve servicemembers, retirees, and family
members).
Organization
The CG-11 Director is typically a U.S. Public Health
Service (USPHS) flag officer (O-8) assigned to USCG
Headquarters and serves as the chief medical advisor (i.e.,
Surgeon General) to the USCG Commandant. The CG-11
Director also works under the immediate supervision of the
Assistant Commandant for Human Resources, who reports
to the Deputy Commandant for Mission Support.
The CG-11 Director delegates day-to-day oversight and
administration of the program to the Chief of Health
Services, who also functions as the Deputy Surgeon
General of the Coast Guard. The HSWL Service Center
administers the various health programs under its purview,
which include 14 Regional Practice offices that provide
technical assistance and administrative oversight for all
USCG clinics, and shipboard medical assets.
Budget
Most USCG health-related spending is organized into
several Program, Project, and Activity categories of the
Coast Guard’s Operations and Support account in the
annual DHS appropriation. The fiscal year (FY) 2022
USCG budget includes requests for $1.1 billion in
discretionary funds for health-related spending and $248.9
million in mandatory funds that pay for USCG retiree
health care. These funds are separate from DOD’s Defense
Health Program account that funds the MHS.
USCG Health Services Personnel
A variety of medical professionals staff the USCG Health
Services program, including physicians, dentists, advanced
practice providers, nurses, corpsmen, and administrators. At
the beginning of FY2021, 1,173 personnel were assigned to
the USCG Health Services program. This included a mix of
USCG officers and enlisted servicemembers (67%),
USPHS officers (16%), civil servants (5%), and contractors
(13%).
USPHS Support to USCG
USPHS has historically provided health care support to
USCG, originally through its now-decommissioned Marine
Hospital Service. Unlike other military services, USPHS
comprises a notable portion of USCG’s overall medical
force. By law (42 U.S.C. §253), USCG is entitled to
USPHS support for “medical, surgical, and dental treatment
and hospitalization.” A 1990 Memorandum of
Understanding (MOU) formalizes this medical support
relationship, which assigns USPHS officers to fill certain
USCG personnel requirements on a reimbursable-basis.
USPHS officers may be assigned to a clinic or a ship and
can deploy with certain USCG units.
USCG Health Services
USCG offers a limited range of outpatient medical and
dental care (e.g., primary care; occupational health; flight
medicine; optometry; mental health; physical therapy;
dentistry; and basic laboratory, radiology, and pharmacy
services). USCG delivers these health care services in fixed
U.S. health care facilities, ships, and certain deployed
environments. USCG operates 43 shore-based outpatient
clinics in the United States (see Figure 1) and no inpatient
facilities. The clinics function similarly to DOD’s military
treatment facilities (MTFs).
Figure 1. USCG Shore-Based Clinics
Source: CRS graphic based on data provided by USCG officials,
August 2020.
Note: USCG clinics in Guam and Puerto Rico are not depicted on
this map.
