The development of penicillin to treat bacterial infections ushered in the age of antibiotics and offered the promise of elimination of death from bacterial diseases. For most of the 50 years since, the promise, although not reached, seemed a reasonable goal. Now, the emergence and spread of antibiotic resistant bacteria lead many experts to wonder if current and under-development antibiotics are sufficient to contain certain lethal bacterial diseases.
Antibiotic resistant bacteria are common in the nations hospitals because antibiotic sensitive bacteria cannot survive where antibiotics are commonly used. Antibiotic resistant bacteria infect about one million hospital patients each year. Antibiotic resistant bacteria are much less common in the community,the non-hospital environment. This may be changing. If antibiotic resistant bacteria are becoming more common in the community, the problems posed by bacterial infections will increase in parallel.
OTA will analyze the literature and talk with experts to determine the prevalence of antibiotic resistant bacteria and changes in prevalence over time. A special focus will be placed on determining the extent to which bacteria such as pneumococcus and enterococcus, which are common causes of infection but treated with current antibiotics, are becoming antibiotic resistant. OTA will describe public and private commitment to antibiotic research and the factors which influence the level of effort.
In addition to being used to treat human diseases, antibiotics are used in veterinary medicine and for prophylaxis against diseases in food animals and in fish farms. Experts agree that the widespread use of antibiotics favors the emergence and spread of antibiotic resistant bacteria, and OTA will discuss the relative importance of different uses of antibiotics. OTA will present options for dealing with the problems posed by antibiotic resistant bacteria.
Project Director: Michael Gough 228-6686
Estimated publication date: Spring 1995.
Requested by: House Committee on Energy and Commerce
Endorsed by: Senate Committee on Labor and Human Resources
The growing impact of AIDS on the Nations health continues, despite the optimism generated by the discovery and rapid approval of the first palliative drug against the AIDS virus and preliminary testing of possible vaccines. Preventing the spread of the AIDS virus is the primary strategy that is available, but is dependent on as yet unresolved differences on when testing for infection is appropriate and on how to alter the behavior of high-risk groups. The Nations and even many other countriessocial, economic, legal, and political systems have all been affected to some degree by the appearance of AIDS, and controversies over AIDS have even begun to affect international relations and comity among nations. Congress has responded with rapid increases in Federal funds for scientific and medical research and for research and services in preventive education, and has begun to grapple with the difficult issues involved in financing AIDS-related health care. These diverse issues warrant a different approach from the usual OTA assessment, so this project is oriented toward a monitoring and advisory capability within OTA to assist the increasing number of congressional committees that have AIDS on their agendas.
Project Director: Michael Gluck 228-6590.
Estimated publication date: Indeterminate.
Associated publications: Issues Related to Development of AIDS Vaccine(BP), Winter 1995.
"Update on How Effective is AIDS Education?" (BP), Summer 1995.
External Review of Federal Centers for Disease Control and Preventions HIV Prevention Programs: Summary and Overview(BP), published September 1994.
Difficult-to-Reuse Needles for the Prevention of HIV Among Injecting Drug Users(BP), published September 1992.
The CDCs Case Definition of AIDS: Implications of Proposed Revisions(BP), published June 1992.
HIV in the Health Care Workplace(BP), published October 1991.
The Effectiveness of Treating Drug Addiction and The Spread of AIDS Virus(Staff Paper), published September 1990.
How Has Federal Research on AIDS/HIV Disease Contributed to Other Fields?(Staff Paper), published April 1990.
Impact of AIDS on the Northern California Region of Kaiser Permanente(Staff Paper), published July 1988.
How Effective Is AIDS Education?(Staff Paper), published June 1988.
AIDS and Health Insurance: An OTA Survey(Staff Paper), published February 1988.
Do Insects Transmit AIDS?(Staff Paper), published September 1987.
Requested by: Technology Assessment Board, with encouragement from the House Committee on Appropriations
In the 1960s, shortages of health professionals received the most attention from policymakers. The Federal government responded with legislation to increase the supply of health professionals by providing grants to health professions schools for construction and loans to students. By the 1970s, efforts to increase the number of health professionals were succeeding, but policymakers recognized geographic and specialty maldistribution as a problem. The Health Professions Educational Assistance Act of 1976 (Public Law 94-484) emphasized training for primary care providers who would practice in underserved areas. Titles VII and VIII of the Public Health Service Act authorized programs to provide support to educational institutions (through grants and contracts), students, and residents (through loans, loan guarantees, and contracts) in the health professions. Those framing the legislation expected that the expansion of the number of primary care practitioners would also lead to more practitioners serving in rural areas and other medically underserved areas of the country. Despite these efforts, there is an increasing trend toward specialization among health professionals in this country. And many areas, particularly rural and inner-city areas, continue to be medically underserved.
This study will assess the effectiveness of current programs funded under Titles VII and VIII of the Public Health Service Act in increasing the supply of primary health care providers and increasing the number of health professionals practicing in medically underserved areas. In addition, OTA will formulate policy options concerning optimal use of Federal funds to further Congressaims in this field.
Project Director: Robert McDonough 228-6590.
Estimated publication date: Fall 1995.
Requested by: Senate Committee on Labor and Human Resources
Congress has been concerned for many years with serious and growing problems of health care costs, access, and quality. Too often, these problems have been addressed as independent issues. Recently, however, attention has been paid to their common elements and interactions, in particular the relationship between the level or type of individualshealth insurance coverage (or the lack of insurance coverage) and the individualshealth status, health outcomes for specific medical conditions, and the timing, nature, and location of health technologies used. The relationship between health insurance status (financial access), health outcomes, and use of health technology is critical because there are more than 31 million uninsured people (nonelderly) and perhaps 20 million to 60 million additional people with inadequate health insurance coverage in the United States (refers to those whose coverage does not protect them from health care expenses that equal or exceed 10 percent of their income). Insurance status and ability to pay for health care may not only affect the timing but even whether someone seeks care at all; and there is growing evidence that, in many instances, the eventual effects may be unnecessary deaths, more serious illness, and higher costs of health care. Thus, financial coverage (including public and private sources) affects not only access but also the quality and costs of health care.
The goal of this OTA assessment is to provide an objective, rigorously critiqued analysis of the often complex, sometimes disputed, network of relationships between health insurance status (either lack of insurance coverage or having inadequate coverage) and negative health outcomes, poor health status, and the timing, location, and nature of health technologies and services delivered. It is the intent of OTA to provide Congress with a clear picture of these important relationships in the context of the U.S. health care system and its financing so that Congress can take them into account as it considers substantial changes in national health policy.
Staff Contact: Denise Dougherty 228-6920.
Estimated publication date:
Associated publications: "Benefit Design in Health Care Reform: Mental Health Services and Substance Abuse Treatment" (R), Winter 1995.
Universal Health Insurance and Uninsured People: Effects on Use and Cost(BP), published September 1994.
Benefit Design in Health Care Reform: Clinical Preventive Services(R), published September 1993.
Benefit Design in Health Care Reform: Patient-Cost Sharing(BP), published September 1993.
Health Insurance: The Hawaii Experience(BP), published June 1993.
An Inconsistent Picture: A Compilation of Analyses of Economic Impacts of Competing Approaches to Health Care Reform by Experts and Stakeholders(R), published June 1993.
Does Health Insurance Make a Difference (BP), published September 1992.
Requested by: Senate Committee on Labor and Human Resources
The United States spends a larger share of its gross national product (GNP) on health can than any other country. This trend, which began about 12 years ago, shows no sign of abating. In 1988, U.S. per capita health expenditures wereat $2,140already $546 more than in Canada, which was in second place. By the turn of the century, according to Health Care Financing Administration projections, this sector of the Nations economy will consume 16.4 percent of the GNP (one dollar in six) up from 12.3 per cent (one dollar in eight) today. The goal of the proposed OTA assessment is to: 1) identify how differences in organization, adoption and use of medical technologies among industrialized countries contribute to differences in costs and health outcomes; and 2) how differences in the structure of health financing, payment, and regulation among industrialized countries contribute to the different patterns of technology use among countries.
Project Director: Hellen Gelband 228-6590.
Estimated publication date:
Associated publications: Health Care Technology and its Assessment in Eight Countries(BP), published September 1994.
Hospital Financing and Expenditures in Seven Countries(BP), Winter 1995.
International Perspectives on Health Care Administration in the United States(BP), published September 1994.
International Perspective on Spending for PhysiciansServices in the United States(BP), Winter 1995.
International Health Statistics: What the Numbers Mean for the U.S.(BP), published November 1993.
Requested by: House Committee on Ways and Means and its Subcommittee on Health
It is estimated that 15 to 24 million Americans have osteoporosis,a condition in which bone mass, density, and quality are diminished, causing a persons bones to be fragile and highly susceptible to fracture. Older people are far more likely than younger people to have osteoporosis, and women are more likely than men to have it, but 20 percent of people with osteoporosis are men. At least 1.3 million fractures attributable to osteoporosis occur each year. The cost of osteoporosisprimarily the cost of medical and nursing care for people with hip fractureswas estimated to be $6 to $10 billion in 1986. As the older population grows, so will the number of people who have it, the number of fractures, and the associated costs.
Since there are no proven methods for reversing osteoporosis, prevention is a primary objective. Many people already have osteoporosis by the time they are 65, so prevention generally must take place in younger age groups. Some methods of preventing osteoporosis are medical treatments, and other methods involve lifestyle changes, including diet and exercise. Anecdotal evidence suggests that some people are worried about osteoporosis but confused about how to prevent it.
Osteoporosis often is not diagnosed in an individual until he or she has sustained a fracture, by which time, prevention may no longer be a possibility. The capacity of existing technologies to detect bone loss early in the disease process and the cost of the technologies are key questions in deciding what the role of screening should be in any initiative to prevent osteoporosis.
Project Directors: Katie Maslow 228-6688
Robert McDonough 228-6590
Estimated publication date:
Associated publications: Cost Effectiveness of Screening for Osteoporosis(BP), Winter 1995.
Public Information About Osteoporosis: Whats Available/Whats Needed?(BP), published September 1994.
Research and Training Issues in Osteoporosis(R), Winter 1995.
Hip Fracture Outcomes in People Age 50 and Over: Mortality, Service Use, Expenditures and Long-term Functional Impairment(BP), published September 1993.
Requested by: Senate Special Committee on Aging
Senator Charles E. Grassley
Senator John Glenn
Representative Thomas J. Downey, Chairman,
House Select Committee on Aging, Subcommittee on Human Services
Representative Olympia J. Snowe, Ranking Minority Member,
House Select Committee on Aging, Subcommittee on Human Services
Representative Benjamin A. Gilman
Representative Patricia F. Saiki
Representative Brian J. Donnelly
Studies of possible long-term health effects stemming from aspects of military service in Vietnam were mandated in 1979 (Public Law 96-151) and 1981 (Public Law 97-72). Both laws require the approval of study protocols and monitoring of approved studies by OTA. The Centers for Disease Control were given responsibility for designing and carrying out these studies in 1983, and, with OTA approval, have been engaged in two studiesthe Vietnam Experience study and the Selected Cancers Studysince then. CDC has stated and OTA concurred that a large-scale Agent Orange study is not feasible. OTA will continue to monitor the two ongoing studies. A recent law (Public Law 99-272) contained a mandate for a study of women Vietnam veterans, and OTA is functioning similarly in regard to this study. Thus far, no protocol has been approved.
Similar responsibilities have been mandated to OTA by legislation (Public Law 98-160) related to atomic veterans,military personnel exposed to atomic weapons testing.
Project Director: Hellen Gelband 228-6590.
Estimated publication date: Ongoing.
Requested by: Mandated study
The Prospective Payment Assessment Commission (ProPAC) is an independent advisory committee mandated under the Social Security Amendments of 1983 (Public Law 98-21) which reforms the Medicare program payment method for inpatient hospital services.
Under the statute, the OTA Director is charged with selecting the Commission members. Initial Commissioners were appointed in 1983 and each year since then the Director has made reappointments or appointed new Commissioners to fill openings created by Commissionersterms expiring.
Key Contact: Clyde Behney 224-3695.
The Physician Payment Review Commission (PhysPRC) is also an independent advisory committee mandated under the Consolidated Omnibus Budget Reconciliation Act of 1985 (Public Law 99-272). PhysPRCs purpose is to advise Congress and the Executive Branch on possible ways of reforming physician payment under the Medicare program.
As with ProPAC, under the statute, the OTA Director is charged with selecting the Commission members. The initial 11 Commissioners were appointed in June 1986, to terms ranging from 1 to 3 years. In October 1986, the Director appointed two new members to the Commission in response to the Sixth Omnibus Budget Reconciliation Act (Public Law 99-509) which increased the number of Commissioners from 11 to 13. Each year since then, the Director has made reappointments or appointed new Commissioners.
Key Contact: Clyde Behney 224-3695.