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How Will the Patient Protection and Affordable Care Act Affect Liability Insurance Costs?

April 14, 2014 Comments off

How Will the Patient Protection and Affordable Care Act Affect Liability Insurance Costs?
Source: RAND Corporation

The Patient Protection and Affordable Care Act (ACA) will greatly expand private coverage and Medicaid while making major changes to payment rates and the health care delivery system. These changes will affect traditional health insurers, individuals, and government payers. In addition, a considerable amount of health care is paid for directly by or is indirectly paid for via legal settlements after the care occurs, by liability insurers. This report identifies potential mechanisms through which the ACA might affect claim costs for several major types of liability coverage, especially auto insurance, workers’ compensation coverage, and medical malpractice. The authors discuss the conceptual basis for each mechanism, review existing scholarly evidence regarding its importance, and, where possible, develop rough estimates of the size and direction of expected impacts as of 2016. They examine how each mechanism might operate across different liability lines and discuss how variation across states in legal rules, demographics, and other factors might moderate each mechanism’s operation. Overall, expected short-term effects of the ACA appear likely to be small relative to aggregate liability insurer payouts in the markets in question. However, under reasonable assumptions, some mechanisms can generate potential cost changes as high as 5 percent or more in particular states and insurance lines. The authors also discuss longer-run changes that could be fostered by the ACA that might exert more significant effects on insurance claim costs, including shifts in tort law, changes in physician supply, new pricing approaches under the accountable care organization model, and changes in population health.

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EU — The future of public health: A horizon scan

April 10, 2014 Comments off

The future of public health: A horizon scan
Source: RAND Corporation

Public Health England (PHE) commissioned RAND Europe to undertake a horizon scanning study exploring the future of public health and related scientific services. This work was intended to help inform thinking at the strategic level within PHE, firstly in relation to the wider vision of the Agency (which was only established in April 2013) and, secondly, in relation to the proposals for the creation of an integrated public health science hub.

The report is based on a literature review, a brief Delphi exercise using the ExpertLens platform and key informant interviews with a range of PHE staff and external experts. It focuses on the different future public health science needs and the extent to which an integrated science hub could serve PHE as it evolves over the next twenty years. Thus, the report considers PHE’s future remit and objectives in order that decisions about an integrated and co-located science hub be made in context and with reference to expert perceptions about the future.

Improving Interagency Information Sharing Using Technology Demonstrations: The Legal Basis for Using New Sensor Technologies for Counterdrug Operations Along the U.S. Border

April 3, 2014 Comments off

Improving Interagency Information Sharing Using Technology Demonstrations: The Legal Basis for Using New Sensor Technologies for Counterdrug Operations Along the U.S. Border
Source: RAND Corporation

The Department of Defense (DoD) has developed new sensor technologies to support military forces operating in Iraq and Afghanistan. These new capabilities may be useful in counterdrug (CD) operations along the southern U.S. border. DoD has held technology demonstrations to test and demonstrate new technologies along the southern border — because the field conditions along the border closely resemble those in current military theaters of operation and because they can also reveal whether new technologies are useful for CD operations led by domestic law enforcement agencies. However, there are legal questions about whether such technology demonstrations fully comply with U.S. law and whether advanced DoD sensors can legally be used in domestic CD operations when they are operated by U.S. military forces.

In this report, the authors examine federal law and DoD policy to answer these questions. Some parts of U.S. law mandate information sharing among federal departments and agencies for national security purposes and direct DoD to play a key role in domestic CD operations in support of U.S. law enforcement agencies, while other parts of the law place restrictions on when the U.S. military may participate in law enforcement operations. Reviewing relevant federal law and DoD policy, the authors conclude that there is no legal reason why a DoD sensor should be excluded from use in an interagency technology demonstration or in an actual CD operation as long as a valid request for support is made by an appropriate law enforcement official and so long as no personally identifiable or private information is collected. The authors recommend DoD policy on domestic CD operations be formally clarified and that an approval process should be established for technology demonstrations with a CD nexus.

Venture Capital and Strategic Investment for Developing Government Mission Capabilities

April 2, 2014 Comments off

Venture Capital and Strategic Investment for Developing Government Mission Capabilities
Source: RAND Corporation

A wide range of military capability improvement efforts have benefited from development and procurement methods that accommodate urgent operational needs. Changes in the threat environment suggest a need for a fresh examination of the adequacy and suitability of acquisition methods for the coming decade. This report examines one class of acquisition method, known as government venture capital (GVC), or government strategic investment (GSI). The research extracts general observations from previous cases and from a partial economic model of the GSI type of initiative. Taken together, these analyses will help government acquisition managers to judge more thoroughly the suitability of strategic investment methods for motivating future government mission–oriented innovation by private firms.

The report does not explicitly compare GSIs and alternatives for their efficacy in advancing government mission objectives. If it had, it is likely that the main advantage of GSI would be improved access to information about alternative approaches available in the commercial market, resulting from the close relationships the GSI structure engenders between government and business.

A Health Care Puzzler

April 1, 2014 Comments off

A Health Care Puzzler
Source: RAND Corporation

An American Life Panel survey finds that a lack of knowledge about health reform and health insurance is especially acute among the poor, less educated, young, and females. This presents challenges for implementation of the Affordable Care Act.

Markets for Cybercrime Tools and Stolen Data: Hackers’ Bazaar

March 28, 2014 Comments off

Markets for Cybercrime Tools and Stolen Data: Hackers’ Bazaar
Source: RAND Corporation

Criminal activities in cyberspace are increasingly facilitated by burgeoning black markets for both tools (e.g., exploit kits) and take (e.g., credit card information). This report, part of a multiphase study on the future security environment, describes the fundamental characteristics of these markets and how they have grown into their current state to explain how their existence can harm the information security environment. Understanding the current and predicted landscape for these markets lays the groundwork for follow-on exploration of options to minimize the potentially harmful influence these markets impart. Experts agree that the coming years will bring more activity in darknets, more use of crypto-currencies, greater anonymity capabilities in malware, and more attention to encrypting and protecting communications and transactions; that the ability to stage cyberattacks will likely outpace the ability to defend against them; that crime will increasingly have a networked or cyber component, creating a wider range of opportunities for black markets; and that there will be more hacking for hire, as-a-service offerings, and brokers. Experts disagree, however, on who will be most affected by the growth of the black market (e.g., small or large businesses, individuals), what products will be on the rise (e.g., fungible goods, such as data records and credit card information; non-fungible goods, such as intellectual property), or which types of attacks will be most prevalent (e.g., persistent, targeted attacks; opportunistic, mass “smash-and-grab” attacks).

The Structural Genomics Consortium: A knowledge platform for drug discovery

March 27, 2014 Comments off

The Structural Genomics Consortium: A knowledge platform for drug discovery
Source: RAND Corporation

The Structural Genomics Consortium (SGC) supports drug discovery efforts through a unique, open access model of public-private collaboration. This report presents the results of an independent evaluation of the Structural Genomics Consortium, conducted by RAND Europe with the Institute on Governance. The evaluation aimed to establish the role of the SGC within the wider drug discovery and public-private partnership (PPP) landscape, assessing the merits of the SGC open access model relative to alternative models of funding R&D in this space, as well as the key trends and opportunities in the external environment that may impact on the future of the SGC. It also established the incentives and disincentives for investment, strengths and weaknesses of the SGC’s model, and the opportunities and threats the SGC will face in the future. This enabled us to assess the most convincing arguments for funding the SGC at present; important trade-offs or limitations that should be addressed in moving towards the next funding phase; and whether funders are anticipating changes either to the SGC or the wider PPP landscape. Finally, we undertook a quantitative analysis to ascertain what judgements can be made about the SGC’s past and current performance track record, before unpacking the role of the external environment and particular actors within the SGC in developing scenarios for the future.

Lessons for a Negotiated Settlement in Afghanistan — If History Serves as a Guide

March 21, 2014 Comments off

Lessons for a Negotiated Settlement in Afghanistan — If History Serves as a Guide
Source: RAND Corporation

Historical insurgencies that ended in settlement after a stalemate have generally followed a seven-step path. A “master narrative” distilled from these cases could help guide and assess the progress toward a negotiated settlement in Afghanistan.

Democracy in Afghanistan The 2014 Election and Beyond

March 18, 2014 Comments off

Democracy in Afghanistan The 2014 Election and Beyond
Source: RAND Corporation

Afghanistan’s upcoming presidential election is the most important political event in that country’s decade-long transition to democracy. A successful election would be a major blow to the Taliban and al Qaida, and would renew Afghan efforts to bring the war to a favorable conclusion. The defeat of the Taliban in Afghanistan would be a major setback for similar groups worldwide, many of which look to Afghanistan as a sort of template for how to accomplish a jihadist takeover. By contrast, a failed election and a renewed push by the Taliban could become a rallying cry and a morale boost to the same groups. Because the stakes are high, the international community should recognize that, despite a dozen years of frustration and halting progress, Afghanistan’s political and economic reconstruction needs one more push before the milestone election. Helping Afghanistan across the electoral finish line will increase the odds that the country will find some sort of solution to its internal stability and, thus, be able to deny safe haven to al Qaida and its affiliates.

Chinese Engagement in Africa: Drivers, Reactions, and Implications for U.S. Policy

March 17, 2014 Comments off

Chinese Engagement in Africa: Drivers, Reactions, and Implications for U.S. Policy
Source: RAND Corporation

Most analyses of Chinese engagement in Africa focus either on what China gets out of these partnerships or the impacts that China’s aid and investment have had on African countries. This analysis approaches Sino-African relations as a vibrant, two-way dynamic in which both sides adjust to policy initiatives and popular perceptions emanating from the other. The authors focus on (1) Chinese and African objectives in the political and economic spheres and how they work to achieve them, (2) African perceptions of Chinese engagement, (3) how China has adjusted its policies to accommodate often-hostile African responses, and (4) whether the United States and China are competing for influence, access, and resources in Africa and how they might cooperate in the region.

The authors find that Chinese engagement in the region is primarily concerned with natural resource extraction, infrastructure development, and manufacturing, in contrast to the United States’ focus on higher-technology trade and services as well as aid policies aimed at promoting democracy, good governance, and human development. African governments generally welcome engagement with China, as it brings them political legitimacy and contributes to their economic development. Some segments of African society criticize Chinese enterprises for their poor labor conditions, unsustainable environmental practices, and job displacement, but China has been modifying its approach to the continent to address these concerns. China and the United States are not strategic rivals in Africa, but greater American commercial engagement in African markets could generate competition that would both benefit African countries and advance U.S. interests.

Topics in Migration Research (Mexico and Germany)

March 12, 2014 Comments off

Topics in Migration Research
Source: RAND Corporation

With respective emigrant and immigrant stocks that are among the largest in the world, Mexico and Germany are affected by migration like few other countries are. They also exemplify that migratory movements need not be permanent, but are also often less temporary than initially assumed. This dissertation explores topics related to the determinants and consequences of migration in these two countries.

How Big is the U.S. Market for Illegal Drugs?

March 11, 2014 Comments off

How Big is the U.S. Market for Illegal Drugs?
Source: RAND Corporation

Using data from 2000 to 2010, RAND researchers estimated the number of users, expenditures, and consumption for four illicit drugs: cocaine (including crack), heroin, marijuana, and methamphetamine (meth).

See also: What America’s Users Spend on Illegal Drugs 2000–2010

Using Early Childhood Education to Bridge the Digital Divide

March 7, 2014 Comments off

Using Early Childhood Education to Bridge the Digital Divide
Source: RAND Corporation

Technology literacy plays an important role in a child’s ability to succeed in school and later life. Yet, despite rapid growth in society’s use of digital technology, many children in low-income families in the United States are not able to access and use technology in the same ways as their more-advantaged peers. This means they have fewer opportunities to learn, explore, and communicate digitally, and fewer chances to develop the workforce skills they will need to succeed in later life. Early childhood education can play a valuable role in ensuring that low-income children can access technology and learn how to use it. However, there are a number of important issues that need to be addressed. This Perspective frames a discussion on these subjects by exploring the role of early childhood education in bridging the digital divide. We highlight five key questions that need to be considered in the discussion of integrating technology into early childhood education.

Countering Others’ Insurgencies: Understanding U.S. Small-Footprint Interventions in Local Context

February 28, 2014 Comments off

Countering Others’ Insurgencies: Understanding U.S. Small-Footprint Interventions in Local Context
Source: RAND Corporation

This study examines the counterinsurgency strategies and practices adopted by threatened regimes and the conditions under which U.S. “small-footprint” partnerships are likely to help these governments succeed. The report’s findings are derived from a mixed-method research design incorporating both quantitative and qualitative analysis. Simple statistical analyses are applied to a dataset of counterinsurgencies that have terminated since the end of the Cold War (72 in all), and more in-depth analyses are provided of two recent cases of U.S. partnerships with counterinsurgent regimes, in the Philippines and Pakistan. The quantitative analysis finds that the cases of small-footprint U.S. operations that are commonly touted as “success stories” all occurred in countries approximating a best-case scenario. Such a verdict is not meant to deny the importance of U.S. assistance; rather, it is meant to highlight that similar U.S. policies with less promising partner nations should not be expected to produce anywhere near the same levels of success. The majority of insurgencies have taken place in worst-case conditions, and in these environments, counterinsurgent regimes are typically unsuccessful in their efforts to end rebellion, and they often employ violence indiscriminately. The case studies of the Philippines and Pakistan largely reinforce the findings of the quantitative analysis. They also highlight the challenges the United States faces in attempting to influence partner regimes to fight counterinsurgencies in the manner that the United States would prefer. The study concludes with policy recommendations for managing troubled partnerships.

Handling ethical problems in counterterrorism: An inventory of methods to support ethical decisionmaking

February 21, 2014 Comments off

Handling ethical problems in counterterrorism: An inventory of methods to support ethical decisionmaking
Source: RAND Corporation

This document presents the findings of a study into methods that may help counterterrorism professionals make decisions about ethical problems. The study was commissioned by the Research and Documentation Centre (Wetenschappelijk Onderzoek- en Documentatiecentrum, WODC) of the Dutch Ministry of Security and Justice (Ministerie van Veiligheid en Justitie), on behalf of the National Coordinator for Counterterrorism and Security (Nationaal Coördinator Terrorismebestrijding en Veiligheid, NCTV). The study provides an inventory of methods to support ethical decision-making in counterterrorism, drawing on the experience of other public sectors — healthcare, social work, policing and intelligence — and multiple countries, primarily the Netherlands and United Kingdom.

The report introduces the field of applied ethics; identifies key characteristics of ethical decision-making in counterterrorism; and describes methods that may help counterterrorism professionals make decisions in these situations. Finally, it explores how methods used in other sectors may be applied to ethical decision-making in counterterrorism. It also describes the level of effectiveness that can be expected from the various methods. The report is based on a structured literature search and interviews with professionals and academics with expertise in applied ethics.

This report will be of interest to counterterrorism professionals who are responsible for strengthening ethical decision-making in their organisation. It may also provide insights for counterterrorism professionals who seek new methods to help them make ethical decisions. The findings may additionally be relevant for professionals in other sectors, if complemented with a review of decision-making characteristics in their sector of specialism.

The Future of the U.S. Intercontinental Ballistic Missile Force

February 9, 2014 Comments off

The Future of the U.S. Intercontinental Ballistic Missile Force
Source: RAND Corporation

In the lead-up to the Air Force Ground Based Strategic Deterrent Analysis of Alternatives, RAND was asked to examine and assess possible intercontinental ballistic missile (ICBM) alternatives against the current Minuteman III system and to provide insights into the potential impact of further force reductions. The researchers developed a framework consisting of five categories — basing, propulsion, boost, reentry, and payload — to characterize alternative classes of ICBM and to assess the survivability and effectiveness of possible alternatives. Using existing cost analyses and cost data from historical ICBM programs, they derived likely cost bounds on alternative classes of ICBM systems. Finally, they developed force reduction scenarios, examined their impacts on several key nuclear specialty career fields to understand the implications of reductions on the current organizational structure, and compared sustainment and requirement profiles within the various reduction scenarios.

Improving Federal and Department of Defense Use of Service-Disabled Veteran-Owned Businesses

February 7, 2014 Comments off

Improving Federal and Department of Defense Use of Service-Disabled Veteran-Owned Businesses
Source: RAND Corporation

The report investigates the barriers that service-disabled veteran-owned small businesses (SDVOSBs) may face when attempting to contract with the federal government and the Department of Defense. The government and DoD goals are to award 3 percent of prime-contract dollars to SDVOSBs but current contracting falls below that level. The authors assess the characteristics of service-disabled veterans that support successful business ownership and identify possible barriers to meeting the 3 percent goals.

Intolerance in Western Europe: Analysis of trends and associated factors

February 4, 2014 Comments off

Intolerance in Western Europe: Analysis of trends and associated factors
Source: RAND Corporation

This study, commissioned by the Open Society Foundations, aimed to situate the widely-shared perception of rising intolerance in Western Europe in the context of empirical evidence on high-level trends in intolerant attitudes in Western Europe. Through analysis of European datasets, a review of empirical literature, and assessments of trends in selected individual countries, we explored whether intolerance has risen more in some countries than others, whether it has risen more against particular groups, if such attitudes are particularly prevalent among subgroups of the population and if there are clear patterns of association with trends in wider political, social, economic and cultural factors.

Evaluating the “Keep Your Health Plan Fix”: Implications for the Affordable Care Act Compared to Legislative Alternatives

February 3, 2014 Comments off

Evaluating the “Keep Your Health Plan Fix”: Implications for the Affordable Care Act Compared to Legislative Alternatives
Source: RAND Corporation

President Obama’s promise that Americans could keep their existing health care plans under the Affordable Care Act (ACA) has received increased scrutiny in the wake of millions of Americans having their plans cancelled. These cancellations primarily occurred in the individual or nongroup market, where individuals purchase health care plans directly from an insurer instead of through an employer. Many such plans do not meet the minimum coverage requirements of the ACA, leading insurers to send plan-cancellation notices to their enrollees.

This report describes a comparative analysis of three proposals to remedy the situation: one by the White House, another by Senator Mary Landrieu (D-LA), and a third by Representative Fred Upton (R-MI). The proposals are evaluated based on their potential impact on the ACA-compliant market and the cost and coverage of health insurance. The possibility of each proposal causing a “death spiral,” in which rising premiums and decreasing enrollment undermine the viability of the ACA-compliant market, is also addressed.

The authors find that the three proposals vary from slight to moderate impact on ACA premiums, enrollment, and federal spending, but none of them would result in the unraveling of the ACA-compliant market.

The U.S. Army in Southeast Asia: Near-Term and Long-Term Roles

January 22, 2014 Comments off

The U.S. Army in Southeast Asia: Near-Term and Long-Term Roles
Source: RAND Corporation

This RAND report explores the role and force posture of the U.S. Army in Southeast Asia, both now and out to 2020. The author argues that, under the current, largely benign conditions, the military will focus mainly on supporting defense reform and modernization, facilitating disaster relief response operations, providing assistance to address nonconventional transnational threats, and helping to balance China’s increased influence into the region. If the security outlook in Southeast Asia remains favorable, these mission areas will not fundamentally change over the near term. However, should the general outlook deteriorate — perhaps as a result of a severe economic slowdown — the geopolitical environment will become far less certain and more prone to crisis. Governments that have derived legitimacy from rapid development would suffer from a loss of grassroots support. State-to-state rivalries would become more acute, especially with regard to the South China Sea disputes. And natural catastrophes would take on greater security relevance because of tighter fiscal constraints for underwriting disaster preparedness and response. To meet these challenges, the United States will need to adopt an agile strategy that is thin in physical presence but broad in programmatic execution. Specifically, there are four areas in which the Army should concentrate its efforts: (1) enhancing the defense capacities of partner nations to meet both conventional and nonconventional dangers; (2) concluding new base agreements for hosting small, mission-oriented expeditionary forces; (3) expanding support for regional humanitarian assistance activities; and (4) initiating appropriate responses to counter a more outwardly adventurist China.

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