Requested by: House of Representatives Hon. Jack Brooks, Chairman Hon. Hamilton Fish, Jr., Ranking Minority Member Subcommittee on Courts, Intellectual Property and the Administration of Justice Hon. Robert W. Kastenmeier, Chairman, Hon. Carlos J. Moorhead, Ranking Minority Member HOME DRUG INFUSION THERAPY UNDER MEDICARE May 1992 This report examines the safety and effectiveness of home drug infusion therapy and the circumstances under which it can be appropriately provided. The report also examines the implications of more comprehensive Medicare coverage, and alternative payment policies for this service. Requested by: Senate Committee on Finance Hon. Lloyd Bentsen, Chairman Hon. Bill Bradley Hon. John H. Chafee Hon. Dave Durenberger Hon. John Heinz (deceased) Hon. George Mitchell Hon. David Pryor Hon. Donald W. Riegle Hon. John D. Rockefeller, IV BUILDING ENERGY EFFICIENCY May 1992 This focuses on energy use in buildings, which accounts for over one-third of all energy used in the United States. Significant energy savings in buildings are possible through the use of commercially available, cost-effective, energy efficient technologies; yet adoption rates for theses technologies are often low. Interviews with industry, property managers, homeowners, and others were used to explore why technology adoption rates are so low. Past Federal efforts to encourage energy efficiency are reviewed, and policy options for encouraging the adoption of energy efficient technologies are discussed. Requested by: Senate Committee on Governmental Affairs Hon. John Glenn, Chairman Committee on Energy and Natural Resources Hon. J. Bennett Johnston, Chairman Subcommittee on Energy, Regulation, and Conservation Hon. Timothy E. Wirth, Chairman Hon. Don Nickles, Ranking Minority Member House of Representatives Committee on Energy and Commerce Subcommittee on Energy and Power FUELING DEVELOPMENT: PROVIDING ENERGY SERVICES FOR May 1992 A variety of concerns has directed attention toward establishing greater cooperation among the world's governments in developing policies aimed at systematically fostering energy development in the Third World countries while mitigating the environmental impacts of that development. Increasing the level of energy services in developing countries is essential for advancing their economies and raising standards of living. But greater demands for energy in these countries could cause serious problems, for the countries themselves as well as the rest of the world, unless they are handled in ways that are economically and environmentally acceptable. The study examines the energy sector in developing countries, and energy's linkage with economic and social development, and the local and global environment. Second, the study examines the extent to which technology can contribute to the improved efficiency of energy supply, distribution and use in developing countries, the factors determining the rate of technology adoption, and the potential of these technologies for limiting environmental damage. Case studies provide detailed analysis for the handful of developing countries that account for a large share of total developing country energy. Finally, the study addresses ways in which Congress could encourage the adoption of technologies that promote economically and environmentally sound energy development in the poorer countries. The assessment also includes an analysis of how sales by U.S. energy technology vendors to developing countries could benefit the U.S. trade balance, and the policies of other industrialized countries with regard to the transfer of energy technologies to developing countries. EVALUATION OF THE OREGON MEDICAID PROPOSAL May 1992 Expensive medical technologies, substantial and growing numbers of poor people, general health care cost increases, and tight fiscal situations in the Federal Government and many States wall have contributed to Medicaid difficulties. The State of Oregon has recently proposed a major departure from Medicaid procedures. It seeks a waiver to excuse it from mandated Federal standards for State participation in the program and to put in place a new but untested system. OTA evaluated the mechanics of Oregon's proposed system, including a methodologic critique. Evidence (from the health care literature and elsewhere) on the efficacy and costeffectiveness of selected medical services for women and children was analyzed with particular attention to how well Oregon's rankings reflect the medical evidence on those services. The report also analyzed the potential implications for the health status of poor women and children due to lack of access to selected technologies and services, especially those low on the Oregon rankings. Requested by: House of Representatives Committee on Energy and Commerce Hon. John Dingell, Chairman Subcommittee on Health and the Environment Hon. Henry A. Waxman, Chairman BUILDING FUTURE SECURITY: STRATEGIES FOR RESTRUCTURING THE DEFENSE July 1992 A fundamental question for the long-term national security and economic health of the country is how best to manage an overall reduction in expectation on national security to ensure that the Nation retains an adequate defense industrial and technological base and efficiently converts to civilian production those resources no longer needed for defense. This study. 1) provides Congress with an understanding of the current condition and trends in the defense industrial base; 2) identifies and analyzes a range of possible future force structures and resulting requirements for the future defense industrial base; 3)identifies those elements of the defense industrial base that can be partially or totally converted to civilian use; 4) examines alternatives for facilitating the transition of the defense industrial base to a similar, but response, capability, and 5) identifies ways in which the future defense industrial base can make better use of civilian or "dual-use" technologies and manufacturing. Requested by: Senate Committee on Labor and Human Resources Hon. Edward M. Kennedy, Chairman Hon. Orrin G. Hatch, Ranking Minority Member Committee on Commerce, Science and Transportation Hon. Ernest F. Hollings, Chairman Committee on Foreign Affairs Hon. Claiborne Pell, Chairman Senate Committee on Armed Services Subcommittee on Defense, Industry and Technology House of Representatives Committee on Interior and Insular Affairs Hon. Morris K. Udall, Chairman Committee on Government Operations Hon. John Conyers, Jr., Chairman Subcommittee on Commerce, Consumer and Monetary Affairs Hon. Doug Barnard, Jr. RETIRING OLD CARS: PROGRAMS TO SAVE GASOLINE AND REDUCE EMISSIONS July 1992 This report focuses on light-duty vehicles--automobiles and light trucks--that account for a large portion of urban air quality problems. Although cars of 1971 or earlier vintage made up only about 3.4 percent of the auto fleet in 1990 and were driven less than 2 percent of the miles, the Environmental Protection Agency estimates they created at least 6 percent of the hydrocarbon emissions, 7.5 percent of the carbon monoxide, and 4.7 percent of the nitrogen oxides. Further, because older cars generally are much less fuel efficient than new ones, they burn a disproportionate share of gasoline and thus are responsible for a similarly large share of the environmental economic, and national security effects of gasoline use. Requested by: House of Representatives Committee on Energy and Commerce Hon. Philip K. Sharp, Chairman CYSTIC FIBROSIS AND DNA TESTS: IMPLICATIONS OF CARRIER SCREENING August 1992 Cystic fibrosis is an inherited disorder predominantly characterized by chronic lung disease. Invariably fatal, it is the most common lethal genetic disease in the United States. Currently, DNA analysis can identify 70 to 75 percent of carriers for cystic fibrosis, and hence about 50 percent of couples at risk. Pressure for widespread carrier screening of potential parents for cystic fibrosis is already building, despite caution raised by medical experts. Several companies are aggressively marketing the test, and estimates of the potential market for cystic fibrosis screening range from $200 million to more than $1 billion. The assessment (1) gathers technical information on cystic fibrosis diagnosis and treatment; (2) examines prospects for DNA tests to detect additional cystic fibrosis mutations; (3) analyzes legal, ethical, and economic issues of population screening for cystic fibrosis, including issues related to quality assurance, confidentiality, disability coverage, health insurance, and reimbursement for screening; (4) surveys genetic counselors for their opinions and attitudes toward population screening for cystic fibrosis; and (5) surveys commercial health insurers and health maintenance organizations to assess attitudes, policies, and practices -- present and future -- toward cystic fibrosis screening. Requested by: House of Representatives Committee on Science, Space and Technology Hon. Robert A. Roe, then Chairman Committee on Energy and Commerce Hon. John D. Dingell, Chairman POLICE BODY ARMOR STANDARDS AND TESTING August 1992 This assessment identifies key issues and seek to resolve technical disputes relating to setting standards for concealable body armor for police officers and testing procedures for determining compliance with standards. Requested by. Senate Committee on Judiciary Hon. Joseph R. Biden, Jr., Chairman Hon. Strom Thurmond, Ranking Minority Hon. Edward M. Kennedy Hon. Dennis DeConcini House of Representatives Rules Committee Hon. John Joseph Moakley, Chairman Committee on Judiciary Hon. Edward F. Feighan, Member A NEW TECHNOLOGICAL ERA FOR AMERICAN AGRICULTURE August 1992 The success of the U.S. agricultural industry no longer depends just on production ability - it also requires increased international competitiveness. An increasing need exists to reduce the cost of production and to emphasize economic yields rather than just production yields. Agricultural research plays a vital longterm role in ensuring a successful and profitable industry in this new age. Concern exists that public and private sector agricultural research is not responding to the realities of this new age. This assessment provides information on the emerging agricultural technologies for the 1990's and the structure of the research systems that gives rise to these technologies. The technologies will include biotechnology, information technology, and low input technology for the food and agricultural sector. The study examines such areas as: (1) the impact of emerging technologies on the agricultural sector, (2) Federal funding models in agricultural research, (3) direction and planning of agricultural research, (4) adequacy of the current structure of the public research and technology transfer system, and (5) the changing nature of public and private sector research. Requested by: Senate Committee on Agriculture, Nutrition and Forestry Hon. Patrick J. Leahy, Chairman Hon. Richard G. Lugar, Ranking Minority Member Subcommittee on Agricultural Research and General Legislation Hon. Thomas A. Daschle, Chairman THE BIOLOGY OF MENTAL DISORDERS September 1992 This report presents a summary of research into the biological factors associated with schizophrenia, bipolar disorder, major depression, obsessive-compulsive disorder, and panic disorder. The report also discusses support for this research and the social context in which it moves forward. OTA concludes that there have been important advances in understanding the biology of these disorders, and that rich opportunities for further research exist. The report provides policy options for action by the U.S. Congress in three areas: support for research, implications of research findings, and the dissemination of new information. Requested by: Senate Committee on Commerce, Science, and Transportation Subcommittee on Science, Technology, and Space Hon. Albert Gorc, Jr. House of Representatives Hon. Silvio O. Conte, Ranking Minority Committee on Energy and Commerce Hon. John D. Dingell, Chairman Hon. Robert A. Roe, Chairman GREEN PRODUCTS BY DESIGN: CHOICES FOR A CLEANER ENVIRONMENT September 1992 In response to tougher regulations and greater environmental awareness, many companies are beginning to be more concerned with reducing the wastes they generate. As yet, though, few companies take responsibility for their products after they are discarded by consumers and enter the waste stream. The problem is complicated by the fact that designers are using increasingly complex materials--e.g., multi layer food packaging--that are often more difficult to recycle or re-use. This assessment explores how technologies |