to recruiting minorities into health service careers and creative new strategies to providing health care services for populations in HUD and other public housing projects. I will be pleased to respond to any questions you may have. BIOGRAPHY OF DR. JAMES O. MASON James O. Mason, M.D., Dr. P.H., was sworn in April 21, 1989, as Assistant Secretary for Health, Department of Health and Human Services. Dr. Mason was nominated by President Bush April 7, 1989, and confirmed by the Senate April 19, 1989. Before assuming responsibility for the U.S. Public Health Service, Dr. Mason had served, since 1983, as director of the Centers for Disease Control and administrator of the Agency for Toxic Substances and Disease Registry. During his tenure at CDC, Dr. Mason also served as acting Assistant Secretary for Health from February to December 1985. Dr. Mason served as executive director of the Utah Department of Health, with responsibility for health and health care financing, from 1979 to 1983. He was associate professor and chairman of the Division of Community Medicine, Department of Family and Community Medicine, at the University of Utah College of Medicine from 1978 to 1979. He directed a multiple-hospital health care corporation owned by The Church of Jesus Christ of Latterday Saints from 1970 to 1975. As Assistant Secretary for Health, Dr. Mason directs the activities of the Public Health Service, which includes eight agencies: the Alcohol, Drug Abuse and Mental Health Administration; the Centers for Disease Control; the Agency for Toxic Substances and Disease Registry; the Food and Drug Administration; the Health Resources and Services Administration; the National Institutes of Health; the Indian Health Service; and the Agency for Health Care Policy and Research. Dr. Mason provides policy guidance as well for HHS programs outside of PHS, and maintains relationships with other government and private agencies concerned with health. He advises and assists the Secretary on health policy and on all health-related activities of the department. He Dr. Mason was born June 19, 1930, in Salt Lake City, Utah. received his B.A. and M.D. degrees from the University of Utah in 1954 and 1958. He received his master of public health and doctorate of public health from the Harvard School of Public Health in 1963 and 1967. Dr. Mason served his internship at Johns Hopkins Hospital in Baltimore from 1958 to 1959, and was an internal medicine resident at Peter Bent Brigham Hospital, Harvard Medical Service, in Boston from 1961 to 1962. He has received numerous honors and awards. Among these are the Public Health Service Distinguished Service Medal (1988) and the University of Utah's Distinguished Alumni Award (1973). He is a member of a number of honorary and professional societies including the American Medical Association, the Institute of Medicine of the National Academy of Sciences, and the American Public Health Association. He has served on many national and international committees, councils, boards and task forces, including the United Nations Development Program/World Bank/World Health Organization Special Program for Research and Training in Tropical Diseases, Scientific and Technical Advisory Committee; and the National Institutes of Health Recombinant DNA Advisory Committee. Dr. Mason is certified by the American Board of Preventive Medicine. He has written numerous articles and book chapters on a wide range of subjects related to the prevention and control of disease. He is a national spokesperson on the prevention and control of infectious disease, chronic disease and injury, and a leading architect of public policies concerning these health problems. Dr. Mason and his wife, the former Marie Smith, have five sons and two daughters: James, Susan, Bruce, Ralph, Samuel, Sara and Benjamin. STATEMENT OF DR. J. JARRETT CLINTON I am pleased to appear before you today to discuss the Fiscal Year 1991 budget request for the Agency for Health Care Policy and Research. The Agency for Health Care Policy and Research was established with enactment of the Omnibus Budget Reconciliation Act of 1989 (Public Law 101-239). The purpose of the Agency, as stated by law, is to enhance the quality, appropriateness, and effectiveness of health care services and access to such services through the establishment of a broad base of scientific research, through the promotion of improvements in clinical practice, and in the organization, financing, and delivery of health care services. The new Agency supercedes the National Center for Health Services Research and Health Care Technology Assessment, previously funded in the Office of the Assistant Secretary for Health. The Agency for Health Care Policy and Research is the newest agency of the Public Health Service but it is built on a solid foundation. Over the last two decades, our predecessor, the National Center for Health Services Research and Health Care Technology Assessment, supported research that has directly supported the work of the Congress. For example, our research provided the foundation for: the Medicare DRG payment system and the Rural Health Clinics Act; severity of illness measures, which may be used to approaches for measuring and improving the quality of measures of disability and health status, such as the ADL (Activities of Daily Living) scale that Congress has used to target disability legislation; computerized medical information systems to monitor patients and assist health care providers in diagnosing and treating illness; the design of the nation's Emergency Medical Systems; enhancing the acceptance of the important role that The breadth and scope of these past research efforts has left the Agency for Health Care Policy and Research well-positioned to move quickly and aggressively in the new directions mandated by Congress in the Omnibus Budget Reconciliation Act of 1989. The Fiscal Year (FY) 1991 budget request for the Agency for Health Care Policy and Research is $110,239,000 in total obligations. This represents an increase of $11,401,000 or 11.5 percent over 1990 obligations. The Agency's 1991 budget request is comprised of the following sources of funds: an appropriation from the general funds of the Treasury of $39,126,000; transfer from the Medicare Trust Funds, pursuant to Section 1142(1) of the Social Security Act, of $28,000,000; reimbursement from the Medicare Trust Funds for health care technology assessment, $1,037,000; 40 percent of the maximum amount authorized for evaluations under section 2611 of the Public Health Service Act, pursuant to section 926(b) of said Act, estimated to be $40,776,000; and one-half of one percent available for National Research Service Awards, $1,300,000, pursuant to section 487 (d)(3)(B) of the Public Health Service Act. Medical Treatment Effectiveness: The budget request includes $49 million for the Medical Treatment Effectiveness Program, an increase of $11 million or 29 percent over the FY 1990 level of $38 million. As stipulated in Section 1142(i) of the Social Security Act, two-thirds of the request, or $28 million, will be provided from the Medicare Trust Funds; onethird, or $14 million, will come from the general fund of the Treasury; and an additional $6.5 million from PHS 17 evaluation funds will be allocated for evaluative research under this program. The The Medical Treatment Effectiveness Program is a Presidential initiative to improve the effectiveness and appropriateness of health care services and procedures through a better understanding of the effects of health care practices on patient outcomes. ultimate goal of the program is to provide information to patients and practitioners that will improve the health of our population and optimize utilization of scarce health care resources. This is a departmental program which involves formal collaboration with other agencies of the Public Health Service and the Health Care Financing Administration. Major components of the program are outcomes research and data development, guidelines development, and dissemination and assimilation of findings. Specifically, the program supports the development of scientific knowledge about patient outcomes through: the development of methodologies to support outcomes research; the development and supplementation of databases to support outcomes research; the support and conduct of outcomes research; the dissemination of information derived from outcomes research; and the development and periodic review and updating of clinically relevant guidelines, standards, performance measures, and review criteria. The increase in funds requested for this important Presidential initiative will continue the momentum given to the program in 1990 by providing substantial increases for all components of the program. General Health Services Research and Health Care Technology The budget request for general health services research and health care technology assessment, including dissemination and program support is $51 million in 1991. This includes $14.6 million in budget authority and $1 million to be transferred from the Medicare Trust Funds. In addition, $34.3 million is estimated to be available for evaluations under this program and $1.3 million is estimated to be available for National Research Service Awards . The $14.6 million in budget authority will continue to support approximately the 1990 level for research, and the dissemination of information deriving from research, on health care services and on the systems for the delivery of such services. Specific research includes such activities as health care services in rural areas, clinical practice, health care technologies, health care costs, productivity and market forces, primary care, long-term care, minorities and the disadvantaged, and medical liability. As provided by section 926(b) of the Public Health Service Act $34.3 million is included for evaluative research in general health services and technology assessment in 1991. Of these funds, $20.5 million will support research on the delivery of health services to minorities and the disadvantaged, rural health research, primary care, health promotion and disease prevention, and medical liability. The other $13.8 million will continue support for the National Medical Expenditure Survey and the Hospital Studies Program. The 1991 budget request includes transferring $1,037,000 from the Medicare Trust Funds, the same as 1990, for health care technology assessment activities. Similar to 1990, the Agency for Health Care Policy and Research also will award an estimated $1.3 million for National Research Service Awards in 1991. Acquired Immune Deficiency Syndrome/Human Immunodeficiency Virus: The budget request includes $10.5 million for health services research on AIDS and HIV related illnesses, an increase of $2 million over 1990. The Agency for Health Care Policy and Research will support research to study the availability, cost, and utilization of services for different HIV risk groups, populations, geographic areas, and stages of illness and treatment modalities. The increase of $2 million will expand the AIDS Cost and Service Utilization Survey to address the health resource utilization of the asymptomatic population. Mr. Chairman and Members of the Committee, I will be pleased to answer any questions you may have on the specifics of this budget request. BIOGRAPHY OF DR. J. JARRETT CLINTON EXPERIENCE Present Acting Administrator, Agency for Health Director, Bureau of Health Professions Rockville, Maryland Deputy Assistant Secretary of Defense for Washington, D.C. Associate Administrator for International Public Health Service Rockville, Maryland Agency Director for Health and Population Senior Representative for South and East The Population Council Senior Consultant in International Health Washington, D.C. Population and Health Officer Agency for International Development Jakarta, Indonesia Graduate Student, Department of International Deputy Director and Regional Medical Officer Peace Corps Washington, D.C. Peace Corps Physician Pakistan and India Assistant Surgeon General, 0-8 1983 Senior Fellows Program Diplomate, American Board of Preventive Medicine (Public MEMBERSHIP American Public Health Association Commissioned Officers Association Association of Military Surgeons of the United States |