RAND Review News for Summer 2003

Crises Seen as Catalysts for NATO and EU

NATO and the European Union (EU) have certainly endured crises in the last year, but such conflicts will ultimately lead to stronger, more unified organizations, according to France's Ambassador to the United States Jean-David Levitte, who spoke recently at RAND.

The ambassador acknowledged that the U.S.-led war on Iraq had shaken NATO but said that the organization has since recovered. NATO enlargement also signals the beginning of a new era, he said.

"We are transforming NATO into a completely different organization," said Levitte. "The Soviet Union has disappeared, and the threat now is terrorism."

Similarly, Levitte noted that although the EU has suffered from dissension, it is also on the road to reform. In fact, past experience has demonstrated that a European crisis is sometimes the catalyst for progress. "It's when we have a challenge, when something goes wrong, that we say 'let's do it better next time.'"

Levitte reminded the audience that the European Constitution is now being prepared. "If all goes well, in a few months, Europeans will have a president—a man, a voice, a face for the European Union."

However, Levitte emphasized that the goal of creating a constitutionally unified Europe is not to build a counterweight to U.S. power. Developing a common defense and foreign policy will help create "a common force strong enough to take care of crises at our own doors," he said, referring to the past Balkan crises.

Hispanic Immigrants Show Familiar Progress

Hispanic immigrants to the United States advance socially and economically from generation to generation as quickly as European immigrants did decades earlier, according to a RAND study published in the American Economic Review.

"Based upon our experience with history, the children and grandchildren of Hispanic immigrants progress up the educational and income ladder in the same way as immigrants who came here from European countries," said James Smith, RAND economist.

The advancement leaves thirdgeneration Hispanic descendants only about 10 percent behind their white counterparts in relative incomes. The generation-to-generation educational gains made by Hispanic men are greater than those seen among native-born white and African-American men. However, by the third generation, the educational gains appear to drop off as the statistics for Hispanics begin to resemble those of the remaining U.S. population.

"A lot of the success we have seen from immigrant groups is because of the strong American school system," said Smith. "If the schools fail to deliver, then we have a problem. While history provides an optimistic lesson, there is no guarantee that new immigrants will keep moving upward unless we continue to have a sound educational system.

Disparity Found Among California Charter Schools

California's charter schools produce substantial dissimilarity in student performance at different types of charter schools, according to a new RAND study.

Charter schools are designed, in part, to compete with conventional schools. At least 38 states allow charter schools, with nearly 2,700 of them enrolling more than 600,000 students. California has more than 400 publicly funded charter schools enrolling about 150,000 children.

"Charter schools differ markedly from each other, and consequently there is no single charter school effect on student achievement," said Ron Zimmer, lead author. "From campus to campus, charter schools are so diverse it is impossible to paint a single picture of them. To precisely evaluate performance, you need to consider the type of charter school and the characteristics of the specific charter."

The report recommends that the state create a system of tracking student academic advancement over time and also require that fiscal information from charter schools be monitored by state departments of education, county offices of education, and local school districts. The report further calls for additional research on charter schools that provide a significant amount of instruction outside the classroom.

For more information: Charter School Operations and Performance: Evidence from California (RAND/MR-1700-EDU). Full Document

America Scores Low on Quality of Health Care

Adults in the United States receive, on average, just over half of the health care recommended for a variety of common ailments, according to a study published in the New England Journal of Medicine.

The national study, the largest and most comprehensive ever conducted on health care quality, found that such deficiencies of care pose "serious threats to the health of the American public" and may contribute to thousands of preventable deaths every year.

"Most of us take health care quality for granted. This study shows that we can't," said RAND's Elizabeth McGlynn, who led the study. "There is a tremendous gap between what we know works and what patients are actually getting."

Among the findings, based on interviews and on reviews of medical records:

  • Alcohol-dependent adults receive only 11 percent of recommended care for that condition (see figure).
  • Pneumonia patients receive just 39 percent of recommended care. Nearly 10,000 deaths from pneumonia could be prevented annually through vaccinations.
  • Diabetics receive only 45 percent of the care they need overall. Even worse, less than 25 percent of diabetics have their blood sugar levels measured regularly. Poor control of blood sugar can lead to kidney failure, blindness, and amputation of limbs.
  • High blood pressure patients receive less than 65 percent of recommended care. Poor blood pressure control increases the risks of heart disease and stroke and contributes to more than 68,000 preventable deaths annually.
  • Heart disease patients receive 68 percent of recommended care.
  • Overall, patients failed to gain access to proper medical care about 46 percent of the time.

"What's needed are information systems that can measure care routinely and be linked to systematic efforts to improve quality," said co-author Steven Asch.