Research for Formals

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September 1, 2001
The goal of the Repatriated Prisoners of War (RPOW) program and the Center for Prisoner of War Studies is to evaluate the former prisoners and their experience to learn how to help others from future conflicts. CNA was asked to do a descriptive study of the general health status of prisoners of the Vietnam War, nearly 25 years after their repatriation. We have shown that the RPOWs are now in poorer health than those in the control group and a group of like-aged retired military personnel.
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September 1, 2001
This briefing begins with an overview of how this study began. It then outlines the three specific areas that CNA was asked to study and presents the findings for each of these tasks. First, we would examine administrative costs that are associated with the managed care support contracts. Our second task was to examine several commercial performance standards to be used as benchmarks in our analysis of the military health care system. Finally, we were to examine Region 11 utilization and cost.
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September 1, 2001
As part of the CNA's support to the Robert E. Mitchell Center for Prisoner of War Studies at the Naval Operational Medicine Institute (NOMI), CNA is examining Repatriated Prisoners of War (RPOW) data sources that currently reside at the Mitchell Center. Thirty-four tapes were created with data on Vietnam-era RPOWs. There has been no attempt to make these data available to researchers, or to document the status of the data stored on the tapes. NOMI and the Mitchell Center have asked us to examine all of these data sources to see if they contain information that could be made available to both internal and external researchers exploring the effects of long-term captivity.
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September 1, 2001
This annotated briefing reports the results of a study for the Office of the Assistant Secretary of Defense for Health Affairs (OASD/HA) and the TRICARE Management Activity (TMA) on the Optimization Plan of the Military Health System (MHS). The plan is designed to make the MHS more efficient as well as to increase the overall health of DOD beneficiaries. Our main goal is to determine the link between optimization and several measures of system efficiency. We explore how greater efficiency can increase system capacity so that current workload that is going to the managed care support contractors (MCSCs) can come back into the MTFs). This "recapture" of CHAMPUS workload is the main focus of this study. We examine recapture in several ways: by the military's medical treatment facilities (MTFs) providing more of the inpatient (IP) workload (the overnight stays that go "downtown") and more of the outpatient (OP) visits that today might go to civilian providers. Some of the workload may be part of the Prime network of civilian providers that the MCSCs have set up for DOD beneficiaries, but the majority is for non-network services for which DOD ultimately pays. For both IP and OP workload, we examine whether MTF physicians can provide more of these services and compare the "complexity" of the work with that provided by civilian providers. Lastly, we examine the demand for services, by measuring the demand rates of DOD beneficiaries and how well that demand is managed by local MTFs.
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August 1, 2001
In FY 98, the Navy failed to meet its enlisted recruiting goal by 7,000 recruits, or 12 percent. Early in FY99, it appeared that the recruiting difficulties would continue. All of the military services were facing a tight recruiting market because of such factors as low unemployment, a decreased propensity of youth to enlist, and increasing college enrollments. The Secretary of the Navy responded in February 1999 by increasing the cap on the recruitment of non-high school diploma graduates (NHSDGs) from 5 to 10 percent of enlisted accessions. Although NHSDGs are less costly to recruit than high-school-diploma graduates (HSDGs), both in terms of recruiter time and in marketing, the military services limit the number of NHSDG recruits because they have much higher attrition than high school graduates. Because the Navy was concerned about how the increased numbers of NHSDGs would affect overall recruit survival, it initiated the following two programs: Navy recruiting modified the Compensatory Screening Model (CSM), the screen used to determine NHSG eligibility-the new screen, called the High Performance Predictor Profile (HP3), was implemented with new contacts durine February 1999; and the Commander, Navy Education and Training (CNET) developed a 1-week course for NHSDG recruits called Academic Capacity Enhancement (ACE), which began in March 1999, discontinued during the summer surge, and returned as a fully revised course in October 1999. Commander, Navy Recruiting Command (CNRC) asked CNA to analyze (a) the survival of NHSDGs under these two new policies and (b) the overall cost-effectiveness of the policy to increase the cap on NHSDG accessions. This annotated briefing presents our findings.
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August 1, 2001
The purpose of this research memorandum is to report and comment on the findings of an analysis of Navy Medicine Primary Care (NMPC) to members of the Primary Care Product Line (PCPL) Advisory Board (the Board) and to the Bureau of Medicine and Surgery (BUMED). This report is part of the support that CNA is providing to the product line. It analyzes Ambulatory Data System (ADS) records of visits made to Navy Medical Treatment Facilities (MTFs) during FY 2000, as well as data from two Department of Defense (DOD) surveys that provide information on the satisfaction of users of NMPC. Its intent is to provide empirical information as background to the Board's and BUMED's optimization activities. In this report, we describe what NMPC is, based on what primary care providers (PCPs) do in Navy MTF primary care (PC) settings, and identify how and to what extent the content and nature of NMPC varies by provider and setting. This approaches NMPC from the supply side - what care is provided by whom, and where. Its focus is not on how much care is provided (e.g., number of visits) but rather on the nature and distribution of that care (e.g., percentage of visits by clinical content and provider type).
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August 1, 2001
When the Navy's downsizing ended in the 1990s, undermanning in the fleet became evident. By the end of the decade, fewer than 90 percent of the enlisted billets were filled. Problems with recruiting, distributing, and retaining sailors all contributed to the undermanning difficulties. In response, the Navy fought to reverse the trend by instituting initiatives to alleviate attrition. As part of the Navy's efforts to increase manning through reduced attrition, the Assistant Deputy Chief of Naval Operations, Manpower and Personnel (N1B) asked CNA to analyze the causes of fleet attrition-that is, early separations among sailors who make it to a full-duty billet, both on shore and at sea. Because most fleet attrition occurs soon after arrival in the fleet, we focused on first term attrition. First, we studied the patterns of fleet attrition losses in the Navy. Then we investigated the causes of attrition and how those factors changed in the 1990s. We conducted an analysis of yearly cohort attrition for first-term sailors on both sea and shore duty. Then, restricting our analysis to sailors on surface ships, we explored how the deployment cycle influences attrition, Finally, because attrition is costly, we explored strategies aimed at reducing it and keeping it low.
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July 1, 2001
Since the onset of the volunteer military almost 30 years ago (1973), the American full-time workforce has become more diverse, and the active-duty military reflects that diversity. This paper considers comparisons of full-time, military-age (18 to 44 years) civilian workers and active-duty military personnel in 1970 and 2000. In that 30-year period, percentages of civilian workers changed from 89 to 70 percent white, from 10 to 12 percent black, and from 1 to 18 percent other racial categories. The percentage of women in the civilian workforce rose from 29 to 41 percent. Percentage differences in the active-duty military population between 1970 and 2000 are comparable: from 83 to 65 percent white, from 11 to 20 percent black, and from 6 to 14 percent other racial/ethnic backgrounds. The percentage of women in the military increased from 2 to 15 percent. This research memorandum begins with a discussion of this increased diversity with the Gates Commission and the beginning of the all-volunteer force, and of how representative of society the all-volunteer force is today.
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July 1, 2001
The Navy expects to enlist about 55,000 sailors each year in the near future, and faces the challenge of training and delivering these recruits to operational billets. Accordingly, policy-makers wish to monitor the fraction of recruits who complete training, as well as the time it takes them to reach the fleet. In this report, we track sailors "from street to fleet, " analyzing factors that influence attrition from the Navy during the period of initial skills training. A companion report describes street-to-fleet trends and focuses on the time it takes recruits to reach the fleet. The Director, Assessment Division (N81) requested this study as part of the Navy's Manpower and Personnel Integrated Warfare Architecture (IWAR). The IWAR is a planning vehicle that uses analyses to shape long-range goals and policies. This study examines prefleet attrition from the Navy; it does not investigate losses from the fleet, attrition from specific courses, or transitions between training programs. CNA conducted a regression analysis to define patterns in attrition as they relate to gender, rating, and training time.
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July 1, 2001
CNAC has had a program of seminars with its Russian counterparts since 1991. We have discussed a range of issues, from strategic nuclear matters to naval cooperation. For the seminar we are planning in Russia in the summer or fall of 2001, one of the prime agenda items will be the long-term future of the relation of Russia to European security (assuming the United States has a long-term future relation in Europe as well). As part of our preparations for the seminar, we organized a workshop to discuss the issues of Russia and European security. It was held at CNA on 13 April 2001. The format of the workshop involved five speakers, each addressing one of five scenarios chosen to raise a full range of issues. The scenarios, described in this paper, are: 1) NATO expansion to Russia's borders; 2) bringing Russia into NATO; 3) Russia and Europe gradually converging in matters of security; 4) Europe creates a security infrastructure separate from U.S. and from Russia; and 5) drift in European security arrangements.
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