Background Papers Medical Monitoring and Screening in the Workplace: Results of a Survey $9,800 Screening of prospective employees for health status and certain behaviors and monitoring of workers' health are generally thought to be widespread in American workplaces, but few data exist about either practices. This background paper presents the results of a survey of 1,500 U.S. companies, the 50 largest utilities, and the largest unions. The survey was designed to obtain information about the types of medical monitoring and screening done in the U.S. and the extent of their use. American Military Power: Future Needs, Future Choices $183,869 America's global security environment is changing profoundly, pushing the country toward a fundamental reevaluation of its military requirements and those of the supporting defense technology and industrial base. If U.S.-Soviet relations do not deteriorate, defense procurement could accelerate its present decline through the end of the decade. This background paper outlines some of the issues of importance for making choices about the future nature and role of the U.S. armed forces, and suggests how these choices will affect defense base requirements. HIV in the Health Care Workplace $175,087 Reports of five cases of HIV transmission within a dental practice raised issues regarding patient safety and received much public attention. The Centers for Disease Control's reports of these cases and CDC's subsequent recommendations for preventing transmission of HIV and the hepatitis B virus to patients during exposure-prone invasive procedures have in turn led Congress to consider several actions directed at HIV in the health care workplace. This background paper examines evidence of the risk of HIV transmission in the health care workplace and discusses the policy implications of CDC guidelines and congressional actions in response to this risk. The 1992 World Administrative Radio Conference (WARC 1992: Issues for U.S. International Spectrum Policy) $43,040 A host of new technologies and services, such as digital audio broadcasting, high-definition television, and personal communications services, are vying with existing radio-based applications for a slice of the valuable, but crowded, radio spectrum. The radio frequency spectrum is a common natural resource shared by the nations of the world. The World Administrative Radio Conference meeting in Spain in February 1992 (WARC-92) will attempt to reassign the radio frequencies in order to take advantage of these new applications, while still accommodating the needs of existing users. The background paper examined the U.S. preparations process for WARC-92, highlighting efforts to integrate the needs and concerns of various interest groups. It also reviewed the forces and trends affecting the U.S. as it approached WARC-92, and is intended to inform future congressional oversight of the domestic and international radio communication policy process. The FBI Fingerprint Identification Automation Program: $43,418 This background paper assesses the FBI's strategic plans to modernize and fully automate its fingerprint identification and criminal history record system. The paper focuses on key assumptions that will affect the sizing and procurement of the new FBI system, and on other related steps that appear necessary to ensure complete and up-to-date record systems. These include full implementation of a Federal/State/local partnership for maintaining and exchanging fingerprint and criminal history records; enactment of an interstate compact of Federal legislation setting out uniform rules for the House Committee on Foreign Affairs Hon. Dante B. Fascell, Chairman Hon. William B. Bromfield, Ranking Minority Member U.S.-Mexico Trade: Pulling Together or Pulling Apart? $288,214 Technological changes such as computer-aided manufacturing combined with the evolving strategies of U.S., Mexican, and third-country corporations (e.g., Japanese multinationals) will affect jobs and job opportunities for Americans. The assessment focused on plant location and technology decisions, as revealed by interviews with corporate managers and influenced by local labor market conditions, including prevailing wage levels and available skills. The report includes: 1) analysis of production technologies, particularly in the motor vehicles and parts industry, and in electronics; 2) analysis of corporate locational decisions and the public policy factors affecting them (e.g., environmental and workplace regulations); and 3) analysis of the relative attractiveness of Mexico as a site for foreign direct investment. OTA examined the range of possible impacts on U.S. jobs and job opportunities, in terms of occupational categories and their skill requirements, as well as wage levels. Requested by: Senate Committee on Labor and Human Resources Hon. Edward M. Kennedy, Chairman Hon. Orrin G. Hatch, Ranking Minority Member Hon. Claiborne Pell House Committee on Education and Labor Hon. William D. Ford, Chairman Hon. William F. Goodling, Ranking Minority member Subcommittee on Labor-Management Relations Hon. Pat Williams, Chairman Hon. Marge Roukema, Ranking Minority Member Special Care Units for People with Alzheimer's and Other Dementias: $33,409 Several million Americans have Alzheimer's disease or another disease or condition that causes dementia. As our population ages, the number of people with these devastating diseases and conditions will increase relentlessly. Families take care of individuals with dementia at home for as long as possible, but most individuals with dementia are likely to spend some time in a nursing home in the often long course of their illness. Until recently, little attention has been paid to the special needs of nursing home residents with dementia. In many nursing homes, they have received and continue to receive inappropriate care that exacerbates their cognitive impairments and behavioral symptoms and further reduces their quality of life. This OTA report analyzes the available information about special care units for people with dementia. It discusses ways in which the Federal Government could encourage and support what is positive about special care units and at the same time protect vulnerable patients and their families from special care units that actually provide nothing special for their patients. Requested by: Senate Committee on Aging Hon. David Pryor, Chairman House Select Committee on Aging, Subcommittee on Human Services Hon. Olympia J. Snowe, Ranking Minority Member area. This study evaluates research conducted to date, assesses the extent to which research areas are being addressed, and proposes topics that should be considered in investigating the acute and long-term effects of menopause and designing treatment. Trade and Environment: Conflicts and Opportunities $264,281 Industry throughout the world increasingly must take into account environmental issues such as ozone depletion and climate change. The challenge for American firms and the U.S. government will be to resolve the need for environmentally sound practices with the need to stay competitive internationally. This study examines the context in which trade and environmental issues interact, including how to address environmental concerns in trade negotiations and agreements, what forms of technical assistance our major competitors give their industries in dealing with environmental regulations, and the competitiveness of U.S. business in the growing global market for environmental technologies such as pollution control and waste disposal. It also examines the role U.S. firms and the U.S. government could play in technology transfer to the developing world. Lessons in Restructuring Defense Industry: The French Experience $165,598 This background paper describes the structure and management of the French defense-industrial base and reviews a variety of strategies the French Government and industry are pursing to nationalized the base while preserving key French defense contractors in world markets. Identifying and Controlling Pulmonary Toxicants $158,923 This background paper describes technologies available to identify substances toxic to the lung and Federal efforts to control human exposure to such substances through regulatory and research programs. Disposal of Chemical Weapons: Alternative Technologies $48,649 This background paper briefly describes the Army's chemical weapons destruction program, discusses the factors that could affect a decision to develop state of development of proposed alternatives, discusses the alternatives, and illustrates the difficulty of gaining public acceptance of complex technical systems. CDC's Case Definition of AIDS: Implications of Proposed Revisions $175,087 The Centers for Disease Control's (CDC) AIDS case definition is used to monitor trends in the number and distribution of AIDS cases in the U.S. The AIDS case definition measures severe morbidity due to infection with human immunodeficiency virus (HIV). This information is then used in formulating Federal and State policies for the prevention, treatment, and control of AIDS. In addition, the AIDS case definition has been used in disability determinations by the Social Security Administration. This background paper examines the epidemiologic evidence used by the CDC in deciding to revise the AIDS case definition, and the impact the proposed definition will have on surveillance. The paper also explores the logistical consequences and other implications of the revised definition, including its impact on Social Security disability determinations. Remotely Sensed Data from Space: Distribution, Pricing and Applications $147,329 This background paper focuses on decisions about the future course of the Landsat land remote sensing satellite program and the experiment with commercialization that began in 1984. A consensus is emerging within the government that Landsat 7 will be funded and managed by the public sector. While giving greater assurance that Landsat data will continue to be available for scientists and other users of the data, returning Landsat operations to the public sector creates a new set of problems. Do Medicaid and Medicare Patients Sue $283,342 Whether Medicaid and Medicare patients are likely to sue more or less often than other patients is a critical question in studying the recent trend of reduced physician participation in Medicaid and other publicly funded programs. OTA concluded that these patients are not more likely to sue and may actually sue less often than would be expected on the basis of their medical risks. Does Health Insurance Make a Difference? $90,286 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 $175,087 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. GENERAL ACCOUNTING OFFICE STATEMENT OF CHARLES A. BOWSHER, COMPTROLLER GENERAL OPENING REMARKS Senator MACK. Good morning. I hope we did not keep you too long. I think you know that Senator Glenn was by earlier and made a statement very supportive of the work that you all do and warning us, in essence, that we were going too far. So we appreciate his comments. I think what I will do at this point, Mr. Bowsher, is really turn it over to you, let you go ahead and make your opening statement. And then I have a series of questions that I would go through. Do you have any opening comments that you want to make with respect to Senator BENNETT. No; I do not. Senator MACK. OK. Mr. BOWSHER. OK. Fine. Thank you very much. I will have just a summary here. I will quickly go through it. Senator MACK. All right. Mr. BOWSHER. I would like to just point out that in the 1980's, our staffing was very stable, around 5,300, when you converted to the FTE way of calculating. And we made a lot of management changes in the 1980's. We devolved responsibility down to our issue areas which allowed us to have more people capable to testify. We redesigned our reports. We put in a pay for performance system. We put in a merit promotion system. We worked a lot on our recruiting. So we were able to attract some of the really finest young people in America. We had, sometimes, 7,500 applicants from the best universities. We were able to literally double our productivity in the 1980's regarding the number of audits we were able to do, the number of testimonies, and the amount of dollar savings. The one thing we did not do, though, was to streamline our process and how we did the work. We did it the same way that all the big professional firms did it. That is, we sent the more junior people out to gather the facts and write a draft. And then we reworked the drafts and issued them. When we were doing some work on the quality management area for the Senate Finance Committee, we became more knowledgeable, I think, than most Government agencies about some of these new techniques. TOTAL QUALITY MANAGEMENT We invited Dr. W. Edwards Deming to visit. After that visit we went into a total quality management [TQM] effort to try to improve our processes. And we are still in the process of doing that. |