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  • Author: Katherine Baicker, Theodore Svoronos
  • Publication Date: 07-2019
  • Content Type: Working Paper
  • Institution: The John F. Kennedy School of Government at Harvard University
  • Abstract: Given the complex relationships between patients’ demographics, underlying health needs, and outcomes, establishing the causal effects of health policy and delivery interventions on health outcomes is often empirically challenging. The single interrupted time series (SITS) design has become a popular evaluation method in contexts where a randomized controlled trial is not feasible. In this paper, we formalize the structure and assumptions underlying the single ITS design and show that it is significantly more vulnerable to confounding than is often acknowledged and, as a result, can produce misleading results. We illustrate this empirically using the Oregon Health Insurance Experiment, showing that an evaluation using a single interrupted time series design instead of the randomized controlled trial would have produced large and statistically significant results of the wrong sign. We discuss the pitfalls of the SITS design, and suggest circumstances in which it is and is not likely to be reliable.
  • Topic: Health, Governance, Health Care Policy
  • Political Geography: North America, United States of America
  • Author: S. Fitzgerald Haney
  • Publication Date: 04-2016
  • Content Type: Working Paper
  • Institution: The Ambassadors Review
  • Abstract: The United States’ strong partnership with Costa Rica has deep roots: our countries established diplomatic relations in 1851, when Costa Rican Minister Felipe Molina presented his credentials in Washington, and a Treaty of Friendship, Commerce, and Navigation was finalized the following year. This early cooperation provided a strong foundation for a bilateral relationship that has only gained depth and breadth, and which continues to grow, evolve, and reveal new sources of strength. Today, the United States is Costa Rica’s largest trading partner and greatest source of foreign investment. Costa Rica’s stability, natural beauty, and proximity to the United States make it a favorite destination for US citizens—tourists, investors, and residents alike—further deepening the connections between our countries. Our shared values, long history of close cultural and commercial ties, and growing cooperation on regional initiatives make Costa Rica a valued strategic partner as the United States promotes prosperity, good governance, and security—the three pillars of the US Strategy for Engagement in Central America (the Strategy)—throughout the region.
  • Topic: Diplomacy, Bilateral Relations, Foreign Direct Investment, Governance
  • Political Geography: Costa Rica, United States of America
  • Author: Professor John F. Troxell
  • Publication Date: 09-2015
  • Content Type: Working Paper
  • Institution: The Strategic Studies Institute of the U.S. Army War College
  • Abstract: A recent editorial in The New York Times asked the question, “Who threatens America most?” It proceeded to compare recent pronouncements by incoming senior military leaders, the President, the FBI director, and finally the Director of National Intelligence. The major candidates included the usual nation states (Russia, North Korea, and China), a few nonstate terrorist organizations (ISIS and al-Qaeda), and a couple of unattributed capabilities (weapons of mass destruction and cyberattacks). The editorial concluded with the lament: “If officials cannot agree on what the most pressing threats are, how can they develop the right strategies and properly allocate resources?”1 Given the confusion and uncertainty generated by the current strategic environment, compounded by America’s resource-driven retrenchment, it is a fair question. However, I contend that we could pursue a more focused national strategy and do a better job of allocating resources if we focus on the opportunities as opposed to this wide array of threats. The opportunity that beckons is the increasingly interconnected global economy and the integral role played by the United States in both its institutional design and future evolution. A functioning, interconnected global economy will mitigate most, if not all, of the previously mentioned threats, whereas a fractured and disconnected global economy will exacerbate them.
  • Topic: Conflict Prevention, Security, Economics, Governance, Global Markets
  • Political Geography: Global Focus, United States of America
  • Author: Dr. Joseph R. Cerami
  • Publication Date: 09-2015
  • Content Type: Working Paper
  • Institution: The Strategic Studies Institute of the U.S. Army War College
  • Abstract: The main focus of this monograph is to synthesize the top research on leadership and leader development and to highlight the needs for developing individuals committed to careers of service across the public, private, and nonprofit sectors. The foundation for the research is based on ideas drawn from leadership and management literature, government doctrine and reports, think tank studies, and case studies. The Army has long sought to be innovative in its leader development. Most recently, the Army’s Human Development White Paper supports TRADOC Pamphlet 5250301, The U.S. Army Operating Concept, “Win in a Complex World” document (2014), by emphasizing the Army’s desire to become the nation’s leader in “human development.” In short, the Army Operating Concept requires that emerging leaders must understand the political-social-military environmental context, the defense-diplomatic-development (the 3-Ds) policies of the U.S. Government, and their roles as emerging leaders and followers in a variety of operational settings. Collaboration, not just within the Army, but across government agencies will be crucial to success in this complex operating environment.
  • Topic: Development, Human Welfare, Military Strategy, Power Politics, Governance, Military Affairs
  • Political Geography: United States of America
  • Author: Dr. Sue McNeil, Ryan Burke
  • Publication Date: 04-2015
  • Content Type: Working Paper
  • Institution: The Strategic Studies Institute of the U.S. Army War College
  • Abstract: The 2013-14 Army War College Key Strategic Issues List stated: “If Hurricane Sandy is seen as an archetype of a complex catastrophe, then a careful analysis of the effectiveness of the DoD response within the context of dual status commanders [DSCs], lead federal agencies, and state response capabilities needs to be conducted.” This monograph does exactly that as it carefully and comprehensively analyzes the DSC-led military response to Hurricane Sandy in New York. Through this lens, it illustrates and discusses the perspectives of the DSC construct and offers recommendations for leveraging existing capabilities and improving those deemed insufficient. Using a case study approach, this analysis addresses notable issues of constitutionality, legality, policy, financial considerations, and even politics, all uniquely situated between individual states’ interests and those of the federal government. To provide military and defense officials with a greater understanding of the benefits and limitations of the DSC arrangement during a no-notice/limited-notice incident, this monograph offers objective and systematic documentation of the Sandy response. It concludes by offering a series of actionable recommendations aimed at improving operational decision-making, policy, and legislation specifically related to DSCs during no-notice/limited-notice incidents.
  • Topic: Human Welfare, Natural Disasters, Governance, Military Affairs
  • Political Geography: United States of America
  • Author: Jordan Howell
  • Publication Date: 11-2015
  • Content Type: Working Paper
  • Institution: East-West Center
  • Abstract: With limited space and ever-growing trash, the islands of the Pacific share unique challenges managing their solid wastes. The traditional approach has been to collect waste in open dumps and landfills. But overwhelmed sites and unsanitary conditions are driving governments to seek alternative solutions. Hawai'i has implemented "resource recovery" systems in past decades to deal with waste, including an innovative energy-from-waste project on O'ahu, and a recycling/composting program on Maui that focuses on diverting material from landfills. While both have been successful in reducing waste and generating products, the programs have also endured unexpected delays and problems. Despite differences in scale and capacity, the Hawai'i experience offers insights for other Pacific islands into how to tackle their own solid waste management issues, and create systems and policies that deliver the greatest ecological and economic benefits.
  • Topic: Climate Change, Economics, Energy Policy, Environment, Governance
  • Political Geography: United States of America