RAND 1999 Research Highlights

At RAND, we seek to make a difference—to make life better and safer and healthier for the American public and for people everywhere. The excellence of our work depends on the contributions of a committed staff, and everyone who works at RAND helps pursue this mission.

But how do we tell whether or not we are succeeding? It is crucial that RAND be able to offer objective evidence that its research is promoting thoughtful debate and affecting important decisions. Michael Rich and I believe that the recurring questions we ask about individual projects and about RAND's overall research agenda help provide such evidence. In this overview of key research accomplishments in 1999, I again take the opportunity to make those questions explicit:

• Do our products and services meet the high standards of quality and objectivity that are RAND's core values?
• Are we addressing issues at or near the top of the national policy agenda?
• Are we reaching key decisionmakers, as well as the general public, with the results of our research and analysis?
• Have those products and services contributed to significant changes in policy and practice?

Where all of RAND's work is concerned, we must, of course, be able to answer "yes" to the first question. A positive response to any, and ideally all, of the other questions supports our assertion that we are indeed making a difference. And the existence of this "test"—i.e., our ability to offer evidence of deeds that back up our words—distinguishes us from many institutions that claim to be similar to RAND.

The examples in the following pages clearly meet the requirements of our test, and they highlight a cross-section of our agenda. But they are by no means exhaustive. In a sense, they represent both the pinnacle of achievement and the tip of the iceberg. Moreover, much excellent research—often unsung but certainly not unrecognized or unappreciated—must be done each year to lay the foundation for the studies whose final results affect decisionmaking and change policy.

I am very proud of RAND's accomplishments and its staff, who made 1999 another banner year.

—Jim Thomson

Since 1978, China's reforms and modernization efforts have resulted in an unprecedented rate of economic development. If current trends continue, China may pose a serious geopolitical challenge to the United States in several important ways. It could be a difficult military adversary in East Asia. A militarily and economically strong China might also offer an attractive alternative to the current U.S. "monopoly" as a provider of regional security, thus weakening the U.S. position as the region's preferred security partner. Ultimately, China could seek to limit U.S. political-military access, and possibly economic access, to the region.

The United States and a Rising China reports the results of a two-year study undertaken by RAND's Project AIR FORCE (PAF) to assess the effects of China's growing capabilities on U.S. national security planning and to determine the implications for the Air Force. Concluding that Washington's longstanding strategy of engagement with China is flawed, and asserting that an attempt to contain and slow the growth of Chinese power is inappropriate, the research team offered an alternative approach: Continue to try to bring China into the current international system while preparing for a possible Chinese challenge to it. Moreover, seek to convince the Chinese leadership that such a challenge would be difficult to prepare and extremely risky to pursue.

This report has been praised by Secretary of Defense William Cohen and his staff, who found in it reinforcement for recent policies that the Department of Defense (DoD) has been pursuing. The project has also shaped Air Force thinking about basing posture and particularly about the need for access to Asian operating bases.

To help the DoD realize its vision for fighting future wars, RAND analysts have been supporting the Defense Science Board, primarily with simulation experiments. In the seminal 1999 report entitled Joint Operations Superiority in the 21st Century: Analytic Support to the 1998 Defense Science Board, researchers in RAND's Arroyo Center highlight the limitations of employing airpower and standoff fires alone against a capable opponent. They also identify the problems associated with introducing ground, naval, and air components using traditional doctrine and tactics. Most importantly, their work demonstrates the potential of inserting revolutionary types of forces that operate under new joint concepts of maneuver and firepower.

Current quick-reaction forces can deploy rapidly but are not very maneuverable once they arrive. They can carry out only a limited number of missions and can be bypassed or attacked. The Arroyo Center's proposed concept of agile maneuver capability was derived from several Army and joint agencies. This concept, in combination with long-range fires, changes the equation. The force could set up ambushes or pursue an enemy that decided to bypass it. Should the enemy choose to engage, the reaction force could respond or use its maneuverability to disengage and attack later at a time and place of its choosing.

The work has been briefed to the Secretary of Defense, Vice Chief of Staff of the Army, and many other U.S. and allied decisionmakers. This study has been instrumental in redirecting the thrust of the Defense Science Board, which previously favored sole reliance on long-range precision munitions. Recent high-level directives have embraced the concept of joint operations that have an agile maneuver capability. The research has also significantly influenced the Army's Strike Force, Army After Next, and Future Combat System efforts, and the report has been recommended as a reference for the upcoming Quadrennial Defense Review.

If combat operations are to be successful, it is crucial that fighting forces get what they need when they need it, and at an affordable cost. Since 1995, the Arroyo Center has been working with the Army logistics community to implement Velocity Management (VM), a resource management approach that defines, measures, and continuously improves logistics processes. The results of VM are telling: A high-velocity, streamlined Army supply process now delivers repair parts in half the time it took to deliver them just three years ago.

In 1999 Arroyo analysts added two new methodologies to the VM approach. One has improved inventory performance at several Army installations without increasing risk or investment. The second gives the Army a long-desired capability for diagnosing sources of equipment failure. With each success, VM gains additional currency among senior DoD officials. In addition, the Marine Corps, the Navy, the Defense Logistics Agency, and the United States Transportation Command have requested RAND's help in applying VM to improve their logistics processes.

Today's Air Force must effectively support nearly continuous deployments of relatively small-scale forces for peacekeeping and humanitarian relief missions and still maintain the capability to win major theater wars. Moreover, because of continuing political and economic pressures, the Air Force has withdrawn from two-thirds of its overseas bases since 1981. Now, basing occurs primarily within the continental United States. To meet the challenges of this unpredictable environment, the Air Force has developed the concept of an Expeditionary Aerospace Force (EAF). At the EAF's core are readily tailored and highly effective air and space force packages that can be quickly deployed from the United States to any destination worldwide and be ready to engage in required operations.

Implementing the EAF concept poses daunting logistical challenges. PAF is helping the Air Force redesign its logistics system to ensure that it can support the spectrum of operations, deal with uncertainty in location and timing of deployments, and evolve in response to changing political situations, new technologies, and new weapon systems.

As described in Supporting Expeditionary Aerospace Forces: An Integrated Strategic Agile Combat Support Planning Framework, PAF recommended establishment of a global network of forward support locations to provide munitions, fuel, vehicles, spare parts, engine repair, etc. The support locations would be aligned with forward operating locations chosen from a broad set of possibilities, including abandoned airfields. PAF also created and tested a series of automated planning models that compute support requirements and resources (e.g., supplies, munitions, transportation) and then provide commanders with options to consider.

The PAF concepts have been tested in war games and were partially implemented during operations in Kosovo. In addition, the broader PAF analytic framework gives the Air Force a continuing ability to review and improve its support system design.

Attracting skilled and smart recruits is becoming a critical job for the DoD. More than ever, the services are competing with the private sector for high-quality enlistees and with colleges and universities for qualified young people. As the United States becomes more ethnically diverse, the government will want to tap into new or growing populations who are underrepresented in the military ranks today. RAND researchers have approached the analysis of manpower issues by emphasizing how an understanding of developments in U.S. society as a whole will influence force management. RAND work has shown that solutions to the current recruiting shortfall lie in developing new approaches that respond to societal changes.

In concert with the Army, Arroyo Center analysts designed two new programs to respond to the Army's continuing recruiting shortfalls. The College First program draws in part on recent work from RAND's National Defense Research Institute (NDRI). The program will enhance the Army's position in the college recruiting market by targeting high-aptitude youth interested in attending college before going on active duty. It provides incentives to help cover college costs and bonus payments to offset the wage premium earned by college attendance.

The Education Plus program will expand opportunities for nongraduates and minorities by recruiting high-aptitude youth and sponsoring them to get their GED prior to accession. Launched by the Secretary of the Army, these programs will be tested in a national experiment designed by RAND that will run at least two years.

In the first cross-service inquiry into the relationship between reenlistment and personnel deployments arising from peacetime military operations, an NDRI study found the opposite of what many feared would be the case.

Does Perstempo Hurt Reenlistment? shows that having some long or hostile duty tends to increase reenlistment in all four services. Such duty, e.g., a tour in Bosnia or deployment aboard a ship, provides service members with an opportunity to serve their country actively and may contribute experience valuable to their service careers.

But tacking an additional tour atop the first or extending sea duty beyond the expected length tends to reduce that higher likelihood of reenlistment. The negative effect of the additional duty is stronger when it involves danger.

The research was useful to DoD because it offered hard evidence on the retention effects of today's heightened pace of peacetime operations. The findings imply that balancing the burden across personnel might actually increase retention, whereas adding duty to personnel who have already had duty could reduce their retention.

While the frequent-deployment issue accounts in part for the pilot retention problems currently being experienced by the Air Force, it does not entirely explain why large numbers of experienced pilots are leaving as their initial service or bonus-payback commitments expire. These losses also occur because commercial airline demand is strong, and they have caused unprecedented peacetime shortages, especially among fighter pilots.

The shortfall of experienced pilots is most keenly felt in operational units, where flight leaders and instructors are needed to supervise the development of new pilots. As the ratio of experienced pilots to newcomers drops, inexperienced pilots each fly a smaller share of the squadron's sorties; therefore, they develop more slowly and take longer to become experienced.

As part of its ongoing research on training, compensation, and retention issues, PAF recommended actions that the Air Force could take to mitigate this problem, including the following: Place experienced reserve pilots in active units to help control the shortfall and increase the number of qualified supervisors. Send a modest number of new pilots to reserve and guard units to be trained.

In 1999, the research results were made available to a "summit" of four-star generals. Several of the recommendations are now being implemented.

Are government efforts to boost the early learning of our children working? If so, do the benefits outweigh the costs? In 1999, RAND Education evaluated some of the most important and ambitious school reform efforts in the country, including California's massive K–3 class size reduction initiative.

Since 1996 California has invested $1 to $1.5 billion annually in reducing the average class size in first through third grades from 30 to 20 students. Receiving $650 (later raised to over $800) for every student in a class of 20 or fewer, schools have been jumping at the opportunity. But despite enthusiasm among educators, parents, and the public, worries have surfaced about the trade-offs being made to find enough space and teachers and about whether all students are benefiting equitably.

In Class Size Reduction in California: Early Evaluation Findings, 1996–1998, RAND researchers show that third-grade students in smaller classes do achieve slightly higher SAT-9 scores (a difference of less than .1 standard deviation). On the other hand, the program has caused a decline in teacher qualifications as districts statewide have had to employ nearly 24,000 new teachers.

The study also found that benefits and costs of the program have been unevenly distributed: Low-income, high-minority districts, overcrowded to begin with, have been slow to implement the program because of space limitations and have suffered the steepest decline in teacher qualifications.

RAND findings point to the need for some mid-course policy adjustments, including strengthening statewide efforts to bolster teaching, promote school construction, and provide incentives for good teachers to take and keep jobs at schools where they are most needed. Attention to these matters may help ensure that the persistent achievement gap for many of the state's poor and minority students will, as hoped, be narrowed by this reform.

In other related 1999 reform evaluations, RAND researchers have identified key determinants of the cost of class size reductions. Instructional costs of a national class size reduction policy, for example, can run anywhere from $2 billion to over $11 billion per year. This depends on how small classes must be, whether implementation is flexible, and whether the policy is targeted toward at-risk students. Policymakers will benefit from this information as they continue to make equitable and efficient improvements in the quality of education.

RAND Education also continues to evaluate the implementation and performance of New American Schools, one of the most important efforts at whole-school reform in the country. This assessment, involving over 100 schools nationwide, will continue until the end of school year 1999–2000.

The stakes are rising in the American system of civil justice. Hundreds of millions of dollars in liability payments as well as the international competitiveness of some of America's most influential corporations rest on the decisions of our nation's lawmakers. Not surprisingly, the work of RAND's Institute for Civil Justice (ICJ) on monitoring this system, analyzing procedures, and evaluating options for reform has gained national prominence.

Class action litigation is the highest-priority issue in the civil justice reform world. Long a matter of controversy, the roiling public debate has been about whether, when, and where damage class actions should be allowed. Those in favor of drastic change argue that bounty-hunting trial lawyers have increased the amount of litigation dramatically, imposing higher costs on business and greater burdens on the courts. Proponents of class actions contend that the suits are a necessary means of securing remedies for wronged consumers and mass tort victims while encouraging more responsible behavior on the part of corporate defendants.

RAND's forthcoming study, Class Action Dilemmas: Pursuing Public Goals for Private Gain, is the first large-scale objective study addressing the history of class action rules, the attempts to change them, and the massive litigation that has resulted. RAND analysts make recommendations for procedural change that would require federal judges to exercise more oversight in the settlement of these cases. "The single most important action that judges can take to support the public goals of class action litigation is to reward class action attorneys only for lawsuits that actually accomplish something of value to class members and society," the analysts declare.

An executive summary of the study was released in 1999 in the midst of intense political maneuvering on Capitol Hill. The work has been cited in both houses of Congress, and off-the-record briefings for the House and Senate have been requested on both sides of the aisle.

Another high-priority civil justice reform issue concerns aviation accident litigation. With commercial air travel becoming routine for millions of passengers, and the number of passenger miles flown expected to double over the next 15 years, the National Transportation Safety Bureau (NTSB) has become a critical link in ensuring the safety of the traveling public in the United States and throughout the world. As the most important independent safety investigative authority in the world, the NTSB exerts enormous influence based on the independence and accuracy of its investigations.

In the wake of recent high-profile crashes and their lengthy investigations, critics have begun to question the appropriateness of NTSB operations, in particular the "party process." Historically a key component of the agency's procedures, the party process involves airlines, manufacturers, unions, the Federal Aviation Administration, and other key stakeholders in agency investigations. But when accidents often lead to lawsuits against these same parties, issues of conflict of interest arise.

Drawing on a diverse research team with expertise in law, defense, and aviation, the ICJ undertook the most comprehensive examination of NTSB operations in the agency's 30-year history. The RAND team found that the NTSB should include more sources of independent, analytical expertise, such as academia and federal laboratories, in the party process in order to improve the effectiveness and integrity of its work. In addition, researchers recommended that the agency acquire additional resources, modernize its investigative procedures, and reform its management practices. According to NTSB Chairman Jim Hall, "We have already begun the process of change and improvement they recommended to ensure that the Board continues to serve the American people in the best way possible."

Assuring long-term self-sufficiency of residents is a key goal of California policymakers. In 1996, Congress passed the most significant social welfare reform legislation since the War on Poverty. In response to the legislation, California created the California Work Opportunity and Responsibility to Kids (CalWORKs) program—a "work-first" program helping recipients move from welfare to work and self-sufficiency.

To find out how the program has been faring, the California Department of Social Services contracted with RAND to conduct an independent evaluation. In 1999 RAND's Labor and Population Program released results from the first phase of a planned three-and-a-half-year study. Researchers highlighted several themes for further investigation, including understanding and dealing with recipient noncompliance, maintaining adequate sources of funding, and helping participants find and keep jobs that pay well. With the state's welfare reform effort still in its early stages, RAND's findings will play a valuable role in shaping the future of state welfare recipients.

RAND Health researchers are conducting an ongoing project to examine the costs and effectiveness of a variety of state and federal policies intended to increase insurance coverage. Among the most important findings from this work is an estimate of how the 1997 Children's Health Insurance Program (CHIP) would affect access to care for uninsured children.

The researchers found that, across the country, CHIP promises to raise the number of low-income children who will be newly insured and to substantially increase their access to physician services. But the magnitude of the effects will vary greatly from one state to another, with the biggest improvements in access to care likely to occur in states that have traditionally provided the scantiest health safety nets.

The research was reported in "Geographic Variation in Physician Visits for Uninsured Children: The Role of the Safety Net" (Journal of the American Medical Association, June 1999). This article received the Sixth Annual Health Care Research Award from the National Institute for Health Care Management Research and Educational Foundation.

Depression is one of the three leading causes of disability worldwide. Although effective medication and psychotherapy treatments exist, depression is often not detected or treated appropriately in primary-care settings. Yet a team of RAND Health researchers found that it doesn't take expensive, elaborate, mandatory treatment protocols or highly trained specialists operating in academic settings to make a big difference in the mental health, daily functioning, and job-holding ability of depressed patients.

The researchers conducted a study that involved more than 27,000 patients, 125 health care providers, and 46 primary care clinics located in counties ranging from the poorest to one of the wealthiest in the nation.

Each practice nominated leaders (a doctor, a nursing supervisor, and a mental health specialist), and the study team trained them to educate other staff in implementing programs to improve quality of care. The team also provided them with written and videotaped materials for this purpose.

Physicians and patients were given enriched opportunities to be informed about both medication and therapy, but they were free to make their own choices. In effect, both practices and patients were trained to improve themselves.

One year after program implementation, the results were striking. The interventions greatly increased rates of counseling and of appropriate use of antidepressant medication compared with that of patients in the "care-as-usual" clinics. Patients in the intervention programs were also less likely to be clinically depressed over the year, and they had better quality of life.

Even more striking from a policy perspective, a substantially higher number of patients in the program remained in the work force at 12 months than did their care-as-usual counterparts. Thus, the program significantly mitigated the detrimental effect of depression on employment. No other quality-improvement evaluation for any condition in primary care has shown the same level of positive employment boost.

The team's report appears in a January 2000 issue of the Journal of the American Medical Association, which also prepared a video news story to make the results of this research available to a wider audience.

In late 1996, the Department of Defense's Special Assistant for Gulf War Illnesses asked RAND to summarize the scientific literature on the health effects of eight possible causes of illness among Gulf War veterans, including pretreatment against nerve agents.

Pyridostigmine bromide (PB) is a drug that was taken during the Persian Gulf War by an estimated 250,000 U.S. troops as a pretreatment to protect against the nerve agent soman. The Department of Defense (DoD) knew that Iraq had weaponized certain nerve agents and feared that soman might be one of them.

PB had been approved in 1955 for treatment of myasthenia gravis, an autoimmune disease that affects the muscles, and it was also approved for certain post-anesthesia applications. During the Gulf War, PB was designated an "investigational new drug" in nerve-agent pretreatment, and it was supplied to U.S. forces under an FDA waiver of informed consent.

A researcher in RAND's Center for Military Health Policy Research conducted an exhaustive study of the PB literature and concluded that PB "cannot be excluded" as a contributor to illness in veterans of the Gulf War. More research into the effectiveness and safety of PB for humans is needed. The issue is a complex one that involves trading off uncertain, but biologically plausible, health risks against uncertain benefits from use of PB in a warfare setting.

The study has been briefed at the highest levels in DoD. In late 1999 it was presented in testimony to the Sub-Committees on Health and Oversight and Investigations, Committee on Veterans' Affairs, U.S. House of Representatives. The research results have also attracted considerable media attention, including press briefings on Capitol Hill and appearances of the author on network news programs.

For nearly two decades, RAND has conducted pioneering work in assessing the quality of medical care. One of its most important contributions has been the development of the RAND/UCLA Appropriateness Method, a tool for identifying overuse or underuse of specific medical procedures.

The method has three key elements. First, a literature review identifies patient characteristics relating to a specific treatment and generates a comprehensive list of descriptions—or indications—for possible use of a procedure. Second, a panel of experts rates the indications on the basis of their appropriateness—the likelihood that the benefits of a procedure will greatly outweigh its potential harm, or vice versa. Third, panel results are applied to actual practice, either retrospectively or prospectively. Retrospectively, quality of care can be assessed by comparing panel judgments to records of actual patients who received (or did not receive) the procedure. This determines the extent of appropriate and necessary care. Prospectively, panel ratings are used to design guidelines for patient management.

For the past three years, RAND Europe analysts have coordinated an effort by eleven health services research centers in seven European countries to promulgate, refine, and expand the use of the Appropriateness Method. In 1999, this approach was applied in a multi-national context for the first time. Contrary to the fears of many observers, it was found that differences in culture, language, and health care financing systems need not be a barrier to reliable and valid use of the method. The work was described in the Autumn 1999 issue of Eurohealth. The project has been greeted with enthusiasm in European health policy circles because of its ability to help improve health care delivery within resource-constrained budgets.

Around the world, nations have been grappling with the presumed trade-off between economic development and environmental protection. Based on an implicit assumption that conventional power-generating technologies (such as those using coal) are less expensive than more efficient, less-polluting technologies (e.g., renewables such as photovoltaics), industrialized and developing countries reached an impasse during recent United Nations climate change negotiations.

Developing countries are reluctant to reduce local pollution and greenhouse gases if it means sacrificing their economic development, especially when industrialized countries continue to emit greenhouse gases from their fossil-fuel-based economies.

To help the world's decision-makers resolve this dilemma, RAND's Science and Technology Program researchers developed a simulation model that included the effects on economic growth of all system-wide power generation costs (e.g., transmission and distribution, fuel and support infrastructure, and air emissions such as oxides of sulfur and nitrogen). The study showed that, under many circumstances in developing countries, renewable technologies are comparable in cost with fossil-based technologies, and they achieve significant local and global environmental benefits.

This groundbreaking research is likely to affect the decisionmaking of developing nations, lending institutions, and industrialized nations as they seek global opportunities to reduce greenhouse gas emissions. The 1999 report Developing Countries and Global Climate Change: Electric Power Options for Growth was issued in Washington at a press teleconference with a global audience and has been briefed to government representatives and the global media.

Dramatic economic and political upheaval in Southeast Asia over the past two years brought instability to the Indonesian archipelago with rippling effects throughout the international economy. Researchers in RAND's Labor and Population Program were well-positioned to analyze the impact of this crisis. Having just completed the second wave of the Indonesian Family Life Survey at the end of 1997 when the Indonesian economy collapsed, they were able to launch a follow-up survey in 1998. Conducted in collaboration with the Demographic Institute of the University of Indonesia, both surveys have yielded unique insights into the complex effects on individual and family well being.

With skyrocketing food prices and an average decline of 25 percent in real purchasing power, the proportion of the average household budget allocated to rice and staples increased by about 50 percent between 1997 and 1998. Health and education expenditures were squeezed, particularly among the poorest households. The most long-lasting blow to the country's future may prove to be the dramatic decline in poor families' ability to provide their children with education and health care.

As described in The Real Costs of Indonesia's Economic Crisis: Preliminary Results from the Indonesia Family Life Surveys, policies keeping children in school and maintaining preventive health care services appear to be what is most needed. Dropout rates for poor students increased substantially, creating economic inequalities in education. Use of public health care facilities also declined between 1997 and 1998, with use of preventive health care by young children dropping the most. These findings will inform the debate on the consequences of the Indonesian crisis and the appropriate response by international donor agencies.