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A Cost-Benefit Analysis of Shipboard Telemedicine
September 1, 1997
Telemedicine (TM) is an umbrella term that covers various technologies used to transmit information for health services. TM uses electronic information and communication technologies to provide and support health care when distance separates the participants. In an effort to enhance medical services at sea, the Navy is considering taking TM beyond the demonstration phase by installing the equipment on over 300 ships and Fleet Marine Force units. Because this would be a significant investment, the Surgeon General has asked CNA to determine the cost-effectiveness of the technology. We conducted a cost-benefit analysis on four telemedicine modalities: telephone and fax, e-mail and internet, video-teleconferencing, and teleradiology. These TM modalities can be enhanced with various digitized diagnostic instruments. We also conducted a cost-benefit analysis on the following instruments: dermascope, ophthalmoscope, otoscope, stethoscope, endoscope, electrocardiogram and defibrillator, and ultrasound.
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OBJECTIVE ALLIANCE 96: A Look at French Navy-U.S. Navy Interoperability
February 1, 1997
As part of an effort to improve their ability to operate together in peacetime, crises, and war, the French Navy and the U.S. Navy have held a series of war games to explore interoperability issues over the coming decade. In May 1996, the two navies continued this effort in a war game held at the Naval War College in Newport, Rhode Island. This war game, OBJECTIVE ALLIANCE 96, challenged the players to explore interoperability issues in a contingency operation in the year 2005. The game focused on sea-based aviation operations and the use of naval aviation for combined power-projection operations. In addition, the game examined the challenges of operating at the highest level of interoperability (combined as opposed to coordinated or independent operations). This research memorandum reviews OBJECTIVE ALLIANCE 96 game play and player recommendations, compares OBJECTIVE ALLIANCE 96 with the 1994 French Navy-U.S. Navy war game, and provides a set of analytical judgments based on the game play and discussions.
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Operation Uphold Democracy: Observations on Joint Assault Forces Operated From a CV
July 1, 1996
In September 1994, after months of unsuccessful diplomatic negotiations to restore the legally elected president of Haiti, the United States undertook the forcible removal of the military junta then in power. As part of this effort, two aircraft carriers (CVs) left Norfolk with a rather unusual mission. The fixed-wing aircraft and most of the air-wing personnel assigned to each of the CVs had been removed to make room for joint (mostly Army) assault forces and the helicopters to carry and support them. These forces were to have been the cutting edge of the planned assault of Haiti. This report contains observations of the operation of those forces from the CVs, with an emphasis on air operations.
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Avoiding A Hollow Force: An Examination of Navy Readiness
April 1, 1996
Since 1989, the Navy has decommissioned 165 ships, seen its endstrength fall by nearly a quarter, and had its budget reduced by $38 billion -- a net reduction of 32 percent. These cuts have raised fears that the Navy may once again be on the verge of a hollow force. Our review of the readiness literature suggests that hollowness is a condition that keeps ships from living up to their design potential. It is the general state that persists whenever maintenance problems dominate a force; when poor quality sailors seem the rule rather than the exception; and when meaningful training is both scarce and questionable. In the 1970s and early 1980s, the Navy experienced all of these problems and more. This paper summarizes the stages of our work on this issue and discusses the insights and key findings we have made along the way.
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Determining Navy Primary Care Requirements
January 1, 1996
There are basically two different approaches to determining requirements of staffing a primary-care-based system. Both approaches have their strengths and weaknesses, but we found that the optimization model, although technically feasible from a modeling point of view, wasn't an approach we could follow and complete. The primary disadvantages concern the need for certain kinds of data. To determine who should staff a primary care system and how generalists and specialists substitute for each other, you need to carefully define who can do what. We used HMO staffing ratios for a large number of medical subspecialities. After applying these ratios to Navy beneficiary populations at 22 U.S. naval hospitals and nine overseas naval hospitals, we derived the kinds of staffing that would be observed had the HMO provided care for these beneficiaries.
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Current Housing Allowance Methodology: Anomalies and Alternatives
January 1, 1996
This analysis begins with a review of the current expenditure-based system. The system uses member survey information on housing expenditures to set the allowance rates. First, we will demonstrate how the current system should work in theory. Second, we will explore some of the problems in the current system either from its theoretical underpinnings or its method of execution. Third, we argue for a price-based alternative to the expenditure-based system. A price-based alternative uses rental prices for units of comparable size and quality to set the housing allowances for the different housing areas.
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Cost and Capability Differences in Land-Based and Sea-Based Tactical Aviation
March 1, 1995
What are the cost and capability tradeoffs between land-based and sea-based tactical aviation? This recurring question reared its head again in 1994, when the Air Force presented certain cost data to the Commission on Roles and Missions (CORM). That data included cost estimates for F-15 and F-16 tactical fighter wings (TFWs), with each wing consisting of 72 aircraft. The Air Force also estimated costs for what it characterized as a 60-aircraft Navy carrier air wing (CVW), and the CVW's associated aircraft carrier (CV). Examination of the results has brought to light the fact that the model used to generate TFW costs and the one that produced the CVW/CV costs are quite dissimilar conceptually--the differences due largely to the treatment of indirect costs. As a potential contribution to the debate, we developed cost estimates that are directly comparable conceptually. This is a summary report. See 27 950019.00 for the complete study.
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Navy Officer Technical Expertise
May 1, 1994
VAdm. Doyle, USN (Ret) and RAdm. Meyer, USN (Ret), among others, have expressed concern to Adm. Kelso, the Chief of Naval Operations, regarding the technical expertise of Navy officers. Their concern is that the decline in officer technical expertise is harming the acquisition process and threatening the capabilities of the U.S. Navy. Adm. Kelso asked CNA to study the issue, and this briefing describes our analysis.
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The Characteristics and Experiences of USN and USMC Women: A CNA Research Bibliography
November 1, 1993
Since 1980, the Center for Naval Analyses (CNA) has conducted a number of studies related to women's service in the United States Navy and Marine Corps. This information memorandum is a bibliography of that research. First, we briefly summarize the recent results related to women's service; next, we explain the format of the publications section. Finally, we list relevant publications--grouped by topic area--with brief summaries.
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Who Will Do What With What? Defining U.S. Navy and Marine Corps Roles, Functions, and Missions
May 1, 1993
At the core of decision-making about U.S. military forces lies the question of what roles and function are assigned to each component of the national defense structure. In theory, resources are then distributed to reflect mission requirements. Today, the nation is in the midst of a review of mission requirements and resource allocations to national defense. This paper provides a backdrop to today's debate by examining the historical debate over 'who will do what with what.' This examination briefly reviews the debates over the U.S. military services' roles, functions, and missions. In addition to a chronological discussion, the paper highlights factors that drive roles and missions debates and relates these factors to today's debate. The discussion emphasizes the U.S. Navy and U.S. Marine Corps perspective. The intent is to provide a sense of how the U.S. military structure arrived at where it is today, thus laying a framework for examining potential alternative future structures and assignments of roles, functions, and missions.
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