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DOES HEALTH INSURANCE MAKE A DIFFERENCE?

September 1992

This Background Paper provides interim results of OTA's assessment Technology, Insurance, and the Health Care System. It reviews the scientific literature linking health insurance status with access to and the use of health services, and with individual health outcomes.

DIFFICULT-TO-REUSE NEEDLES FOR THE PREVENTION OF HIV INFECTION AMONG INJECTING DRUG USERS

September 1992

Some health policy experts have suggested that a redesign of IV injection technology used in the U.S. health care system could lead to a reduction in the spread of HIV among intravenous drug users by eliminating their ability to share injection equipment. This study reviews proposals for needles and syringes that are difficult or impossible for reuse. In addition, it analyzes the potential for drug users to defeat these designs, the likely impact of switching to "single-use" injection equipment on the behavior of drug users, and the impact of such a change on the larger health care system including its costs and its effect on medical waste.

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16.B. Publication Information

Requests for OTA Publications

During fiscal year 1992, OTA's Publications Distribution Office processed over 24,663 telephone and mail requests. Of these, 17,679 were telephone and 6,984 were mail requests. A majority of the noncongressional requests received in the Publications Distribution Office were referred to the U.S. Government Printing Office or the National Technical Information Service for purchase of OTA documents. Additional requests were processed by OTA program offices and the OTA Congressional and Public Affairs Office.

The Publications Distribution Office received requests for multiple copies of many of OTA's reports from congressional offices. The largest number of congressional requests for reports were for:

• Improving Automobile Fuel Economy: New Standards, New Approaches

• Competing Economies: America, Europe, and the Pacific Rim

o Biotechnology in a Global Economy

0 After the Cold War: Living with Lower Defense Spending

• Testing in American Schools: Asking the Right Questions

• Finding a Balance: Computer Software, Intellectual Property and the Challenge of Technological Change

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U.S. Oil Import Vulnerability: The Technical Replacement Capability

o Making Things Better: Competing in Manufacturing

• Miniaturization Technologies

• Summary. Worker Training-Competing in the New International Economy

• Building Energy Efficiency

0 Home Drug Infusion Therapy Under Medicare

Multiple copies of OTA reports and summaries were also requested by various government agencies and private organizations including: ARAMCO Services Company, Motor Vehicles Manufacturing Association; General Motors Corporation; U.S. Department of Labor; University of Georgia; U.S. Department of Agriculture; The Boeing Company, U.S. Chamber of Commerce; Maryland Biotechnology Institute; Industrial Biotechnology Association; Lockheed Missile & Space Company, IBM Corporation; American Society for Training & Development, Inc.; Mississippi Community College Library, Dow Chemical; American Mathematical Society, General Accounting Office; Wellesley College Bookstore; Sandia National Laboratories; U.S. Department of Education; National Science Foundation; National Association of State Boards of Education; U.S. Information Agency, National Governor's Association; NASA; Small Business Administration; National Home Infusion Association; Mt. Sinai School of Medicine; Software Publishers Association; Brown University, U.S. Department of Energy, and National Academy of Sciences.

The Superintendent of Documents, U.S. Government Printing Office, sold out several titles and reprinted eight OTA titles during fiscal year 1992; these include:

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• Global Arms Trade: Commerce in Advanced Military Technology and Weapons

o Redesigning Defense: Planning the Transition to the Future U.S. Defense

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o Finding a Balance: Computer Software, Intellectual Property and the

Challenge of Technological Change

o Informing the Nation: Federal Information Dissemination in an Electronic

Age

Private Sector Reprinting of OTA Publications

OTA publications are sometimes selected by commercial publishers or private organizations for reprinting. For example, in fiscal year 1992 commercial publishers requested to reprint the following:

o Cutter Information Corp. (MA)

Changing by Degrees: Steps to Reduce Greenhouse Gases

o Livestock Industry Promotion Corp. (CO)--translation and reprint U.S. Dairy Industry at a Crossroad: Biotechnology and Policy Choices

Additionally, other agencies, organizations, and magazines requested the use of text, photographs, or other graphics from OTA publications for use in articles and reviews, including:

The Futurist (articles on Testing in American Schools: Asking the Right Questions; Rural America at the Crossroads: Networking for the Future; and Fueling Development: Energy Technologies for Developing Countries);

Civil Engineering (article on Changing by Degrees: Steps to Reduce
Greenhouse Gases);

Environments Journal, University of Waterloo, Waterloo, Ontario (review of Technologies for Prehistoric and Historic Preservation);

The Public Historian (review of Technologies for Prehistoric and Historic
Preservation);

State Education Leader, Education Commission of the States, Denver, CO (information from Testing in American Schools: Asking the Right Questions);

Aviation Week (information from After the Cold War: Living with Lower
Defense Spending)

16.C. Assessments in Progress as of October 1, 1992, and Related Legislation

U.S. ENERGY EFFICIENCY: PAST TRENDS AND FUTURE OPPORTUNITIES Environmental policy and/or economic conditions are increasingly providing incentives for pursuing or mandating energy efficiency and conservation in many economic sectors of the U.S. economy. This assessment focuses on the technical potential and commercial prospects for future efficiency gains. In addition to the full assessment report, several interim reports will be produced that will examine potential efficiency gains from the perspective of major end users: the residential and commercial sector, industry, transportation, and government, and the possible alternative roles of public and private sector involvement in promoting energy efficiency in these sectors.

Possible Impact on Legislation: The report on transportation energy conservation, examines a broad range of mechanisms capable of reducing energy use and greenhouse gas; emissions in the transportation sector, including regulatory, R&D, and incentive programs to boost auto and light truck efficiency and promote alternative fuels; conservation measures such as parking restrictions, HO lanes, forgiveness of tolls for carpools, corporate promotion of vanpools, etc.; energy taxes; targeted transit system rehabilitation, for older, denser cities with existing systems; integrated plans that seek a major shift from private to public transportation; and system problems; and integrated plans that seek large conservation gains with major increases in efficiency and use of alternative fuels, widespread use of intelligent highways to combat congestion, economic incentives to limit travel such as time-of-day charges, energy taxes, changes in tax incentives for parking, etc. Several of these issues are likely to be on Congress's agenda in the coming session.

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RENEWABLE ENERGY TECHNOLOGY: RESEARCH, DEVELOPMENT, AND COMMERCIAL
PROSPECTS

New concerns over energy security, economic growth, and environmental quality are once again focusing
interest on renewable energy technologies. Much has been learned during the past 15 years of work with these
technologies and resources, but the environment in which they are being commercialized has changed
considerably. This assessment of renewable energy technologies will address the technological opportunities and
limits as well as the economic, institutional, and other factors that assist or impede commercialization. These
factors will be addressed for each of the major energy supply and end-use sectors: residential and commercial,
industry, agriculture and forestry, transport, and the electric utility industry.

Possible Impact on Legislation: The Energy Policy Act of 1992 and other legislation dealt with many aspects of renewables, including use of passive solar in buildings, alternative fuels in vehicles, transmission access by independent power producers, renewable energy investment tax credits and production credits, and many

others. Despite this sweeping legislation, a number of issues remain unresolved and will likely be raised in the 103rd Congress. These include: R&D needs for renewable energy technology development; policies to increase U.S. competitiveness in export markets for renewable energy technologies; policies to support utility use of "green pricing," "green RFPs" or other mechanisms to aid in aggregating demand for renewable energy technologies and to minimize transaction costs for small renewable resource developers; policies to encourage utilities to take into account the risk of fossil fuel price increases in planning utility investment portfolios; policies to include consideration of environmental externalities and other social costs in energy planning and pricing; federal lands policies to provide equitable access to renewable energy resources while preserving the broader public interest; performance of the Renewable Energy Joint Venture Program; and evaluation of the various tax and other explicit and implicit subsidies of different energy resources and technologies contained in the Energy Security Act of 1992..

Project Director: Sam Baldwin

Estimated publication date: Spring/Summer 1993

Requested by:

U.S. House of Representatives

Committee on Science, Space and Technology

Hon. George Brown, Chairman

Subcommittee on Natural Resources, Agriculture and
Environment

Hon. James H. Scheuer, Chairman,
Committee on Energy and Commerce

Hon. John Dingell, Chairman

Hon. Norman F. Lent, Ranking Minority Member

Subcommittee on Energy and Power

Hon. Philip Sharp, Chairman,

Hon. Carlos J. Moorhead, Ranking Minority Member

Endorsers

Hon. Charles Grassley, Member of the Technology Assessment Board

U.S. House of Representatives

Committee on Agriculture

Subcommittee on Department Operations,

Research, and Foreign Agriculture

Hon. Charlie Rose, Chairman

Subcommittee on Forests, Family Farms,

and Energy

Hon. Harold L. Volkmer, Chairman

Committee on Appropriations

Subcommittee on Energy and Water Development

Hon. Vic Fazio, Vice Chairman

AGING NUCLEAR POWERPLANTS: LIFE ATTAINMENT, LICENSE EXTENSION AND
DECOMMISSIONING

This assessment will examine the technical, economic, institutional, and safety factors determining the useful lives of existing nuclear power plants. It will examine both the prospects for life extension of nuclear plants, and the cost and performance of those plants in attaining their currently-licensed operating lives. Because one major safety and economic impact of extending plant life is the deferral of nuclear plant decommissioning, this assessment will also examine decommissioning technology.

Project Director: Robin Roy

Estimated publication date: Spring 1993

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