Any overhaul of the military health system must preserve U.S. forces' ability to treat combat casualties and improve access to care, advocacy groups told members of Congress on Thursday.

Testifying before the House Armed Services Committee personnel panel, military organization representatives said the top complaint they receive about the military health system, including Tricare, is patients' inability to make appointments, mainly at military hospitals and clinics.

National Military Family Association executive director Joyce Raezer said reform must fix the long-standing wait time issue and also "change a culture at military hospitals that says it is OK to tell military families with sick children they must call back the next day or go to the emergency room for care."

"We are hearing from families that they have to wait for care, and there also are what I term as 'silly rules' that put barriers up between patients and providers," Raezer said.

"Our survey of over 30,000 folks says the real issue is with Tricare Prime," said retired Navy Vice Adm. Norb Ryan, Military Officers Association of America president. "The greatest dissatisfaction with meeting appointment timelines is for specialty appointments, and the dissatisfaction rate for Tricare Prime, is double, specifically in the military treatment facilities."

The hearing was among several scheduled this year and next to review the military health system, with a focus on reform.

A blue ribbon panel in January recommended changes to the system, including requiring active-duty personnel to use military treatment facilities while family members, retirees and their families would use commercial insurance plans designed specifically for the military population.

MOAA has rejected that proposal, saying the commercial-based Tricare Choice would hinder readiness. It has pushed for streamlining the current system of three service medical commands to one under a single commander with budget authority and maximizing use of military hospitals and clinics.

"The military health benefit should be the gold standard, a top-tier program that is substantially better than those offered by commercial employers. We are not in favor of a [commercial plan] that would allow those with better income to buy better coverage," Ryan said.

NMFA also supports the unified medical command concept and urged lawmakers to create a system that strikes a balance between readiness and providing low-cost, high-quality health care for military families.

Raezer added that NFMA wants all military hospitals and clinics to maintain data on their appointment wait times and certify them as accurate. She said the data now available on access standards indicate most facilities appear to meet the required goals but the information does not mesh with what association members and military population surveys say.

According to Scott Bousum, legislative director for the Enlisted Association of the National Guard of the United States, his organizationsupports the Military Compensation and Retirement Modernization Commission's recommendation for a "Tricare Choice" plan that would allow family members to choose a private health plan that they can keep regardless of whether their service member is mobilized.

"Most Guardsmen and Reservists do not live on or near large military installations," Bousum said. "As a result, many of our members drive hundreds of miles to appointments only to be referred to a specialist, who may or may not be available under Tricare."

Subcommittee members said they are considering all suggestions from military and veterans groups as well as the commission and patients. Subcommittee chairman Rep. Joe Heck, R-Nev., said the committee is "looking to identify areas that need improvement."

"This process is not being driven by budgetary concerns," Heck said. "We are using the same format we used in the successful review of military retirement, which was not driven by budget but by what will produce the best possible benefit to recruit and retain the all-volunteer force."

Heck and Rep. Tom MacArthur, R-N.J., floated several ideas for improvement, to include consolidating the medical system under one command; investing in large military medical centers in regions where a large number of personnel and families live; increasing access to private health care in areas not served by these facilities; and maintaining a robust military health reserve system.

"If we want to say the primary goal is to have a medically ready force, perhaps we focus on military centers of excellence that would be the full inpatient capability MTF located in areas of high troop concentration," Heck said. "If we downscale the other facilities to outpatient clinics, we have to increase access — hours of operation, number of appointments slots and staffing. And for the Guard and reserve, maybe allow them to enroll in [a federal health style] plan."