Research for Formals

Navy Medicine has identified mental and behavioral health as one of the major product line areas for which it wants to develop a strategy for providing these specialty services. To inform this strategy development process, we provide a review of the mental health care delivery models that dominate the U.S. health care delivery system, assess where the Navy stands in comparison to current delivery trends, and outline salient issues regarding potential changes that the Navy should consider as part of its managed care evolution. This report focuses on three types of delivery models: contractual, functional and educational.

As the military health system (MHS) evolves to meet the managed care environment of the peacetime benefit mission, Navy Medicine in particular, and DOD in general, must continue to concern themselves with three principles: (1) Navy Medicine will attract and access quality individuals; (2) the medical department will retain the best of the people accessed; and (3) the best people will want to remain in the military because of the challenge, training, professional ism, and overall environment of Navy Medicine. DOD implemented TRICARE to maximize the quality of healthcare while minimizing the cost of that care. To meet this goal, military medicine must continue to attract and retain quality personnel under this changing work environment. Given these challenges and concerns, the Navy Surgeon General asked CNA to evaluate physicians' job satisfaction within the existing climate to determine whether major problems exist that adversely affect relation of specialists. We have examined Navy physician retention and compensation patterns over the past decade, and find that there has been a decline in retention for the majority of specialists, but the cause and extent of the decline are difficult to quantify. We have attempted to identify the main drivers behind this decline, including compensation, work environment, and promotion opportunity. Contrary to anecdotal evidence, there has been no decline in promotion opportunity] however, we do find that the military- pay gap has been widened by 4 to 24 percent for most specialties during the 1990s.

Evidence suggests that the quality of aviation accessions has been falling. Decision-makers question whether the decline is the result of the active duty service obligations (ADSOs) required of aviators. In a way, these lengthy obligations compensate for the expense of training new aviators to replace those who depart. Traditionally, the aviation community has been able to attract the most promising students, turning away many each year. Is the growing difference between aviation ADSOs and those required in other communities leading the best students to forgo aviation? This annotated briefing discusses CNA's analysis of these issues as requested by N13.

This research memorandum is a product of the USMC Ground Combat Study, which analyzes the size and organization of small infantry units. Our goal is to use this analysis of historical changes in squad size and organization to provide the Marine Corps with an assessment of the future relevance of these units. This report explores the factors behind the emergence of squads, and how and why they have changed in size and organization with time. We believe that understanding the drivers of these changes will allow us to analyze, with some confidence, the kind of impact the complex future warfighting environments that the Marine Corps may face are bound to have on its current 13-man squad. The methodology used in this report is both historical, in that it looks back into the past; and extrapolative, in that it looks forward briefly into the future as well.