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.     

Clinical Characterization of Insomnia among Veterans with PTSD: Identifying Risk Factors for Diagnosis and Treatment with Sedative-Hypnotics

Abstract

Insomnia is prevalent among Veterans with post-traumatic stress disorder (PTSD), it exacerbates PTSD symptoms, and it contributes to impaired functioning and quality of life. To improve treatment outcomes, it is important to identify risk factors for insomnia and sedative-hypnotic use. Classification and regression trees and logistic regression models were used to identify variables associated with insomnia or sedative-hypnotic use. Key findings include low insomnia diagnosis rates (3.5–5.6%) and high rates of sedative-hypnotics (44.2–49.0%). Younger Veterans and those without a breathing-related sleep disorder (BRSD) were more likely to receive an insomnia diagnosis. Veterans with greater service connection and those with an alcohol/substance use disorder were more likely to be prescribed sedative-hypnotics. Interaction terms may have identified potential groups at risk of being under-diagnosed with insomnia (i.e. non-black Veterans with psychiatric co-morbidity, black Veterans without psychiatric co-morbidity) as well as groups at risk for sedative-hypnotic use (i.e. younger Veterans without BRSD). In sum, Veterans with PTSD have high rates of sedative-hypnotic use despite minimal evidence they are effective. This is counter to recommendations indicating behavioral interventions are the first-line treatment. Policy changes are needed to reduce use of sedative-hypnotics and increase access to behavioral insomnia interventions.     

Tipping the scales: short-term interventions and counterinsurgency

Particularly in African operations, United Nations (UN) peacekeeping forces have faced significant problems in restoring stability. In at least a few situations, unilateral national military interventions have been launched in the same countries. In the cases of Sierra Leone and Côte d’Ivoire, the British and French interventions respectively played a significant role in re-establishing stability. Lessons from these operations suggest that if effective coordination and liaison channels are established, such hybrid unilateral-UN missions can in fact be more successful than “pure” peace operations.     

Robustness of preallocated preferential defense with assumed attack size and perfect attacking and defending weapons

The problem is to protect a set of t targets by n perfect interceptors against an attack by m perfect weapons. If the defender solves for an optimal preallocated preferential defense and associated game value assuming m₁ attackers, and the attacker knows the assumption of the defender and utilizes m₂ attackers, he may be able to achieve significantly more damage than had the defender assumed that there would be m₂ attackers. The article treats the robustness of preallocated preferential defense to assumptions about the size of the attack and presents results of an alternative approach.     

同步电机卦限识别技术及轴角数字转换器设计

根据同步电机工作原理提出了一种新的同步电机卦限划分及轴角识别技术,并据此技术,完成了同步电机轴角-数字转换器设计.     

On labeling the vertices of products of complete graphs with distance constraints

Variations of Hale's channel assignment problem, the L(j, k)‐labeling problem and the radio labeling problem require the assignment of integers to the vertices of a graph G subject to various distance constraints. The λ_j,k‐number of G and the radio number of G are respectively the minimum span among all L(j, k)‐labelings, and the minimum span plus 1 of all radio labelings of G (defined in the Introduction). In this paper, we establish the λ_j,k‐number of ∏ K for pairwise relatively prime integers t₁ < t₂ < … < t_q, t₁ ≥ 2. We also show the existence of an infinite class of graphs G with radio number |V(G)| for any diameter d(G). © 2003 Wiley Periodicals, Inc. Naval Research Logistics, 2005     

India's Tortuous Road to Defence-Industrial Self-Reliance

…Rapid indigenisation is the cornerstone of our policy of self-reliance

India MoD Annual Report 1978–9

     

Advancing “Defence-in-depth”: intelligence and systems dynamics

This article aims to encourage the fostering of more systems thinking, and its greater exploitation, within the domain of contemporary intelligence. With particular focus on “micro systems thinking” and with reference to key intelligence processes, such as intelligence analysis, the utility of many systems dynamics within the intelligence context seeks to be further revealed. Through their greater collective harnessing, including up to “System of Systems” (“SoS”) dynamics, and promoting all that they can offer, more sophisticated overarching operational-to-strategic/policy “ends,” notably that of “defence-in-depth,” can be viably further advanced in a sustainable manner into the future. Arguably, a much-needed transformative impact on contemporary intelligence can also be increasingly realised through comprehensively engaging in and with more systems and SoS thinking. Aiding civil protection tasks, crisis management, emergency planners, and civil contingency practitioners likewise gain.     

Military Innovation and Tactical Adaptation in the Israel–Hizballah Conflict: The Institutionalization of Lesson-Learning in the IDF

This article highlights a pattern of military adaptation and tactical problem-solving utilized by the Israel Defense Forces (IDF) while engaged in protracted conflict with the Lebanese militant group Hizballah. It discusses the IDF’s recent attempts to institutionalize their historically intuitive process of ad-hoc learning by developing a formal tactical-level mechanism for ‘knowledge management’. The diffusion of this battlefield lesson-learning system that originated at lower-levels of the organization is examined, as well as its implementation and effectiveness during the 2006 Lebanon War. A nuanced analysis of IDF adaptation illustrates the dynamic interplay between both ‘top-down’ and ‘bottom-up’ processes of military innovation.