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The U.S. Department of Defense (DoD) has increasingly confronted financial, managerial, and operational challenges in sustaining health benefits for service members and their families: For example, medical costs are projected to increase to 12 percent of DoD's total budget in 2015, from a level of 8 percent in 2007. To address these challenges, DoD is working to transform business practices within the Military Health System. As part of this effort, DoD has considered setting targets for health care utilization in its military treatment facilities (MTFs) and rewarding or penalizing MTFs according to their performance. In this volume, the authors discuss the potential and limitations of using MTF utilization and costs as measures of MTF leaders' performance. Nicosia, Wynn, and Romley report the findings of (1) their qualitative review of performance assessment in the nonmilitary health care sector and (2) their quantitative analysis of how MTF utilization and cost metrics are limited by random variation in the data, and how MTF size and resource-intensive catastrophic cases affect this variation.

Medicine, Military --- Health planning --- Evaluation. --- United States --- Armed Forces --- Medical care --- Cost effectiveness.

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Public contracts --- Women-owned business enterprises

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Hospice care --- Medicare. --- Finance.

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Like other states, minorities are disproportionately represented in the California's state prison system, particularly for drug offenses. Unlike other states, California has had a policy of mandatory diversion to drug treatment for non-violent drug offenders since mid-2001 (Proposition 36). Using a rich dataset including current and prior criminal charges from 1995 through 2005 in California, we examine whether disparities in court dispositions to prison and drug treatment between White and Blacks male drug offenders are explained by observable case and criminal justice characteristics. We estimate the extent to which remaining observable disparities are affected by Proposition 36. We find that Black and White male drug offenders differ considerably on covariates, but by weighting on the inverse of a nonparametric estimate of the propensity score, we can compare Blacks to Whites that are on average equivalent on covariates. Unadjusted disparities in the likelihood of being sentenced to prison are substantially reduced by propensity score weighting. Proposition 36 reduces the likelihood of prison overall, but not differentially for Blacks. By contrast, racial disparity in diversion to drug treatment is not reduced by propensity score weighting. There is some evidence that Proposition 36 increased diversion for Blacks.

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We leverage a natural experiment in combination with data on adolescents' time preferences to assess whether there is heterogeneity in place effects on adolescent obesity. We exploit the plausibly exogenous assignment of military servicemembers, and consequently their children, to different installations to identify place effects. Adolescents' time preferences are measured by a validated survey scale. Using the obesity rate in the assigned installation county as a summary measure of its obesity-related environments, we show that exposure to counties with higher obesity rates increases the likelihood of obesity among less patient adolescents but not among their more patient counterparts.