Analysis of an Alternative Military Healthcare Benefit Design

Abstract

The Military Compensation and Retirement Modernization Commission was established by the Congress in 2013 to perform a systematic review of military compensation to address rising costs and other trends. Their recommendation for reforming the TRICARE health care program was sweeping, and differed greatly from earlier proposals that focused on increasing beneficiary cost shares. Specifically, the commission proposed overhauling the current benefit delivery model and replacing it with a premium-based insurance model offering a menu of DoD-sponsored private health plans. The analysis presented here is based on work that supported the commission by estimating the budgetary impact of its proposed reforms. Results indicate that movement towards the premium-based model would produce an annual budgetary cost savings in the $2 billion to $4 billion range, with a best savings estimate of $3.2 billion.     

Computerized scheduling of seagoing tankers

Computerized Scheduling of Seagoing Tankers The tanker scheduling problem considered in this paper is that of the Defense Fuel Supply Center (DFSC) and the Military Sealift Command (MSC) in the worldwide distribution of bulk petroleum products. Routes and cargoes which meet delivery schedule dates for a multiplicity of product requirements at minimum cost are to be determined for a fleet of tankers. A general mathematical programming model is presented, and then a mixed integer model is developed which attempts to reflect the true scheduling task of DFSC and MSC as closely as possible. The problem is kept to within a workable size by the systematic construction of a set of tanker routes which does not contain many possible routes that can be judged unacceptable from practical considerations alone.     

Hyperbolic integer programming

The hyperbolic integer program is treated as a special case of a hyperbolic program with a finite number of feasible points. The continuous hyperbolic program also belongs to this class since its solution can be obtained by considering only the extreme points of the feasible set. A general algorithm for solving the hyperbolic integer program which reduces to solving a sequence of linear integer problems is proposed. When the integer restriction is removed, this algorithm is similar to the Isbell-Marlow procedure. The geometrical aspects of the hyperbolic problem are also discussed and several cutting plane algorithms are given.     

Geometry and resolution of duality gaps

In this study we interpret the exterior penalty function method as a generalized lagrangian metliod which fills duality gaps in nonconvex problems. Geometry and resolution of these gaps from a duality point of view are highlighted.     

Many‐player rendezvous search: Stick together or split and meet?

Rendezvous search finds the strategies that players should use in order to find one another when they are separated in a region. Previous papers have concentrated on the case where there are two players searching for one another. This paper looks at the problem when there are more than two players and concentrates on what they should do if some but not all of them meet together. It looks at two strategies—the stick together one and the split up and meet again one. This paper shows that the former is optimal among the class of strategies which require no memory and are stationary, and it gives a method of calculating the expected rendezvous time under it. However, simulation results comparing both strategies suggest that in most situations the split up and meet again strategy which requires some memory leads to faster expected rendezvous times. © 2001 John Wiley & Sons, Inc. Naval Research Logistics 48:710–721, 2001     

Applying a bootstrap approach for setting reorder points in military supply systems

This paper develops and applies a nonparametric bootstrap methodology for setting inventory reorder points and a simple inequality for identifying existing reorder points that are unreasonably high. We demonstrate that an empirically based bootstrap method is both feasible and calculable for large inventories by applying it to the 1st Marine Expeditionary Force General Account, an inventory consisting of $20–30 million of stock for 10–20,000 different types of items. Further, we show that the bootstrap methodology works significantly better than the existing methodology based on mean days of supply. In fact, we demonstrate performance equivalent to the existing system with a reduced inventory at one‐half to one‐third the cost; conversely, we demonstrate significant improvement in fill rates and other inventory performance measures for an inventory of the same cost. © 2000 John Wiley & Sons, Inc. Naval Research Logistics 47: 459–478, 2000     

Optimal service and arrival rates in Jackson queueing networks

In this paper we present an algorithm for solving a class of queueing network design problems. Specifically, we focus on determining both service and arrival rates in an open Jackson network of queueing stations. This class of problems has been widely studied and used in a variety of applications, but not well solved due to the difficulty of the resulting optimization problems. As an example, consider the classic application in computer network design which involves determining the minimum cost line capacities and flow assignments while satisfying a queueing performance measure such as an upper limit on transmission delay. Other application areas requiring the selection of both service and arrival rates in a network of queues include the design of communication, manufacturing, and health care systems. These applications yield optimization problems that are difficult to solve because typically they are nonconvex, which means they may have many locally optimal solutions that are not necessarily globally optimal. Therefore, to obtain a globally optimal solution, we develop an efficient branch and bound algorithm that takes advantage of the problem structure. Computational testing on randomly generated problems and actual problems from a health care organization indicate that the algorithm is able to solve realistic sized problems in reasonable computing time on a laptop computer. © 2000 John Wiley & Sons, Inc. Naval Research Logistics 47: 1–17, 2000     

Scheduling for parallel dedicated machines with a single server

This paper examines scheduling problems in which the setup phase of each operation needs to be attended by a single server, common for all jobs and different from the processing machines. The objective in each situation is to minimize the makespan. For the processing system consisting of two parallel dedicated machines we prove that the problem of finding an optimal schedule is N P‐hard in the strong sense even if all setup times are equal or if all processing times are equal. For the case of m parallel dedicated machines, a simple greedy algorithm is shown to create a schedule with the makespan that is at most twice the optimum value. For the two machine case, an improved heuristic guarantees a tight worst‐case ratio of 3/2. We also describe several polynomially solvable cases of the later problem. The two‐machine flow shop and the open shop problems with a single server are also shown to be N P‐hard in the strong sense. However, we reduce the two‐machine flow shop no‐wait problem with a single server to the Gilmore—Gomory traveling salesman problem and solve it in polynomial time. © 2000 John Wiley & Sons, Inc. Naval Research Logistics 47: 304–328, 2000     

Scheduling to minimize the total compression and late costs

We consider a single-machine scheduling model in which the job processing times are controllable variables with linear costs. The objective is to minimize the sum of the cost incurred in compressing job processing times and the cost associated with the number of late jobs. The problem is shown to be NP-hard even when the due dates of all jobs are identical. We present a dynamic programming solution algorithm and a fully polynomial approximation scheme for the problem. Several efficient heuristics are proposed for solving the problem. Computational experiments demonstrate that the heuristics are capable of producing near-optimal solutions quickly. © 1998 John Wiley & Sons, Inc. Naval Research Logistics 45: 67–82, 1998