for development and disturbance of another previously undisturbed site, the trade is meaningless if the restoration is inadequately executed. An assessment of ecological restoration could examine questions such as: Do current restoration efforts achieve the stated goals of related Federal laws? Could they if existing technologies were adequately implemented? What areas require R&D? What is the future growth potential of ecological restoration as an industry, and is there potential Federal role in industry development? How do we measure the value of environmental services? RESOURCE MANAGEMENT AND PUBLIC EDUCATION IN THE NATIONAL PARKS Recent internal and external reviews of the National Park Service concluded significant needs exist for increased attention to natural resources in the parks. Traditionally, natural areas were left alone to preserve their natural character. Increasingly, however, influences such as tourism, species invasion, and pollution degrade and damage park ecosystems. As some of the last vestiges of native habitat, park natural areas represent unique national resources. Attention to the problems of park natural areas will require application of technologies either new or at a scale unfamiliar to many park personnel (e.g., ecological restoration and pest control), and education of park users to characteristics and values of natural areas. Needs may exist to develop new technologies or to modify existing technologies from agriculture. In addition, the agency may require significant direction or restructuring by Congress to address these growing problems adequately. Health INFORMATION TECHNOLOGY AND THE HEALTH CARE SYSTEM Recent executive branch proposals to create a single patient records and billing system for the entire country have once again focused attention on the potential benefits, costs, and feasibility of automated patient record systems. With over fourteen years having passed since OTA's Technical Memorandum on Policy Implications of Medical Information Systems, this may an appropriate time for OTA to address a variety issues related to the use of information technology in health care and policy. In addition to considering changes in the technology and diffusion of automated medical record systems, OTA could address the whether information technology has a role in reducing the administrative costs associated with the U.S. health care system, its potential as a tool in studying medical outcomes and other clinical and policy research topics. This project could also address the feasibility and implications of computer-based, interactive clinical decision aids in the practice and teaching of medicine and technology to provide medical advice to health care consumers through computer networks or over the telephone. Finally, the project could follow up some of the findings of OTA's 1988 project, Quality of Medical Care: Information for Consumers, which in part focused on the lack of data necessary to develop and disseminate several potential measures of the quality of health services. MANAGED HEALTH CARE: COST-SAVINGS AND HEALTH EFFECTS Managed care has been cited as a potential cost-saving tool in many health care reform proposals, either as the sole mechanism for containing costs or as one of several that would work in concert to prevent further cost escalation by promoting a more rational allocation of resources. State experiments have demonstrated significant one-time cost savings, but not always an ability to control increases in costs over time. And, when managed care operates under a system that provides financial incentives to reduce services (as in a prepaid, capitated system), the potential for inappropriate restriction of services arises and must be addressed through oversight of quality from an outside entity. OTA's assessment would focus on several questions: What are the different forms of managed care (e.g., prepaid, case-managed fee-for-service) and what level of savings could we realistically expect from each? Second, what level of oversight would be required in order to ensure that quality standards are maintained? Third, what options does Congress have for promoting managed care under health reform (e.g., mandating vs. encouraging) and how would health care providers respond? AIDS STUDIES Possible projects under OTA's ongoing AIDS-related project authority could include looking at one or more of the following topics: the effectiveness of AIDS education and prevention efforts; the status of and liability issues surrounding AIDS/HIV vaccine development; the possible benefits, costs, and other issues surrounding the possibility of testing the blood supply for HIV-II; and the future of HIV/AIDS spread among the injecting drug user population and its implications for other populations. HEALTH TECHNOLOGY UNDER GLOBAL HEALTH CARE BUDGETS Several of the prominent health reform proposals likely to be considered by Congress in its next legislative session, including that favored by President-elect Clinton, include some form of cap or global budget to contain costs. This project would consider how the various ways of applying global budgets would affect health technologies and the providers and patients who use them. It would discuss whether particular types of technologies would be advantaged or disadvantaged under a global budgeting system; how such a system would affect health technology research and development activities; and whether these effects would differ depending on the particular characteristics of the different global budget methods proposed. HEALTH CARE AND THE INNER CITY This assessment would examine the problems surrounding health care in the inner city. The problems specific to or much more prevalent in urban settings include such things as higher numbers of uninsured and poor people, higher homicide and violent crime rates, teenage pregnancy and other risk factors for higher infant mortality, homelessness, and substance abuse and treatment problems and disease incidence associated with it. It would also draw on and tie together our efforts relative to, c.g., tuberculosis, AIDS, and health insurance. The assessment would develop a set of options for dealing with the particular conditions associated with the delivery of health care in these settings. PRESCRIPTION DRUGS AND HEALTH CARE REFORM The prices of prescription drugs have risen at a faster rate than other medical expenditures (10 percent between 1989 and 1990). Currently, consumers pay the majority (72.4 percent) of prescription drug expenditures out of pocket. For some consumers, the price of some "high-tech" or other prescription drugs may be so high as to prevent their use of the drugs. This study will address questions related to the coverage, costs, and quality of prescription drugs in national health insurance reform. Should some or all prescription drugs be offered as a benefit under national health insurance reform? What restrictions should be imposed on their use? How would their inclusion/exclusion affect patients' access to prescription drugs? How would it affect their health status? What mechanisms should be adopted to help control costs? What effect would coverage of prescription drugs have on innovation and drug R&D? 2/ Includes individuals whose services are obtained under contract performing on-site services (in agency workspace) for six months or more during a twelve month period. |