Research for Research Memoranda

The military and civilian health care systems, while distinctly different, share some concerns. These common concerns include the overutilization of inpatient care and the rising cost of medical care. Overutilization is of concern in the private sector for a number of reasons. First, insurance reduces the sensitivity of individuals to health care costs. As a result, people may use too much medical care. Cost sharing and cost containment programs tend to reduce this problem. Second, doctors may increase the use of medical services to increase their own profits and to shelter themselves from malpractice suits (i.e., defensive medicine). Cost containment programs - like concurrent review - help to reduce this incentive. Overutilization is also a concern in the military sector. Like the civilian sector, beneficiaries may use too much health care because insurance reduces the cost of care. In addition, the Department of Defense historically allocated resources to hospitals on the basis of past need. As a result, hospital commander had no financial incentive to curtain hospitalizations. This paper, which is part of a CNA self-initiated study, compares the inpatient use of nine military catchment areas to the civilian sector. The variables we study include: gender- and age-adjusted inpatient admission rate, and case-mix-adjusted length of inpatient hospital stay. Length of stay measures the intensity of treatment once a patient enters the hospital. The inpatient admission rate measures the likelihood of entering the h

As part of the Tricare- Tidewater evaluation, CNA fielded a military beneficiary health care survey in the fall of 1992 to collect information on access, satisfaction, health status, and utilization. To supplement these data, and support the Tricare evaluation, we developed an administrative data set using claims data from the Civilian Health and Medical Program for the Uniformed Services (CHAMPUS), Biometrics records, and Medical Expense and Performance Reporting System (MEPRS) data. This administrative data set provides not only cost information but also detailed utilization records, including information about specific diagnoses and treatments. While working with the survey data, we observed internal inconsistencies in how people responded to the utilization section of the survey. These inconsistencies raised concerns about the veracity of the self-reported use measures. Given these concerns and the unique opportunity of having both survey and administrative measures of use for the same population, we thought it was appropriate to attempt to validate the self-reported utilization data against administrative records. In this paper, we compare the self-reported utilization data to the corresponding administrative utilization data, created from the CHAMPUS Quick Response Data File and Biometrics records, for a subset of our survey respondents. We look at incidences of overreporting and underreporting use in the survey data, and we attempt to explain these occurrences and the impact of this misreporting on aggre

The Consolidated Automated Support System (CASS) is a computerized Automatic Test Equipment (ATE) system that is currently being fielded by the Department of the Navy. Over the next several years, CASS will replace many existing ATE systems and help the Navy standardize test and training procedures. The Director of the Navy's Air Warfare Division (N88) and the Support Equipment Office (PMA-260) asked CNA to review the Navy's current plans for CASS implementation within the fleet. Among other things, these plans call for the phased integration of CASS into carrier Aircraft Intermediate Maintenance Departments (AIMDs). This paper is part of our workload assessment of these plans for carrier AIMDs. Our sponsors wanted answers to two questions: (1) how many (total) CASS stations do carrier AIMDs need?; and (2) more specifically, how many of each type of CASS do they need? In a previous analysis, we explored these questions for CASS support of existing weapons systems only. In this paper, we expand on that analysis by including CASS support of emerging weapons systems as well.

The rapid decline of the defense budget since the fall of the Soviet Union has led to severely reduced procurement accounts for all the Military Services, and these declining budgets are likely to continue well into the next decade. For the Department of the Navy, with its many competing procurement demands, the declining budgets mean that (a) future shipbuilding must be scaled back, and (b) the question of quantity versus capability will become the paramount question as the Navy develops requirements for all new ships. In this paper, which was prepared prior to the start of the Cost and Operational Analysis of the next-generation surface combatant (SC21), I propose that one alternative that should be considered for the SC21 requirement is a set of two ships: a fully capable ship and a moderately capable ship, with the moderately capable design potentially having Coast Guard and foreign military sales application. For maximum standardization and affordability, the two ship types should be designed concurrently by one design team and introduced into the fleet at the same time in a mix consistent with fleet sizing requirements. To meet expected budgetary constraints, both ship types should be developed with firm design-to-cost constraints.