As health care costs threaten to overwhelm the defense budget, the Navy is increasing efficiency through Web-based care, preventive medicine, joint operations across services and fewer referrals to civilian providers, the services top doctor said Wednesday during a visit to San Diego.

The Defense Department spent about $19 billion on health care in 2001. Last year, the figure climbed to $52 billion.

Were on this trajectory that is non-sustainable, said Vice Adm. Matthew Nathan, U.S. Navy surgeon general.

If the trend continues, by 2020 health care costs will consume the budget for discretionary spending, such as infrastructure, Nathan told the San Diego Military Advisory Council.

We cant provide all medical care at any cost anymore. We cant afford it, we cant sustain it, he said, but neither can the Navy simply stop paying the bill.

We have to figure out, Navy medicine and military medicine, how we can maintain health and do it at lower cost.

The Navy cares for sailors and Marines with a budget of about $6 billion and 65,000 workers. That budget will undoubtedly shrink in coming years as the Corps downsizes by about 20,000, Nathan said. But the needs of wounded service members will continue after the last return home from the war.

If all hostilities ended tomorrow, my current need for trauma support would diminish pretty quickly. But my current need for emotional, psychological support will be a tail that exists for quite awhile, he told San Diego reporters.

To become solvent and sustainable, Navy medicine is adopting a patient-centered medical home model, assigning active duty, retirees and dependents it serves to a cluster of providers and encouraging electronic communication.

Like the invention of antibiotics and anesthesia, I believe the next great panacea of medicine is going to be virtual medicine, the ability to take care of you at your homes, where you can use a smartphone or computer to make appointments, get test results and consult with your doctor, he said. The only time youll have to go see a doctor is when youre really sick and they need to either listen to you, see you or feel whats going on with you.

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Navy medicine fights rising costs