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changes overnight (it has taken some 25 years to reduce the prevalence of smoking among males from 52 percent to 32 percent), we believe the Nation can reduce its cancer mortality.


Question. Dr. Mason, the Disadvantaged Minority Health Improvement Act of 1990 was passed by Congress and signed by the President last fall. Does the President's budget for FY 92 recommend funding the programs authorized under the Act?

Answer. The Disadvantaged Minority Health Improvement Act of 1990 established the Office of Minority Health in statute and required that it carry out specific activities. The FY 1992 request for the OMH includes funding for these activities authorized by the law:

o Establishment of short and long-range goals and objectives and coordination of all other activities within the Department related to disease

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prevention, health promotion, service delivery and research concerning disadvantaged and minority individuals ($400,000 for monitoring and implementing the Minority Health Strategic Planning and Coordination Process).

Interagency agreements with other agencies of the
PHS ($4,000,000 for interagency agreements).

Establishment of a national minority health resource center ($750,000 for Office of Minority Health Resource Center).

Support of research, demonstrations and evaluations ($600,000 non-AIDS and $400,000 AIDS for research, demonstrations, studies and analyses).

Coordination of efforts to promote minority health programs and policies in the voluntary and corporate sectors ($850,000 non-AIDS and $150,000 AIDS for assistance to private sector groups).

Development of health information and health
promotion materials, and assistance to providers of
primary health care and preventive health services
in obtaining the assistance of bilingual health
professionals and other bilingual individuals
($3,500,000 for community coalition grants and
$2,500,000 for AIDS education/prevention grants).

The Act also authorized programs administered by the Health Resources and Services Administration (HRSA). The FY 1992 HRSA budget proposes to continue these programs at the current services level, with an expansion of the Health Professions Student Loan Program.




Senator HARKIN. Our next witness is Dr. J. Jarrett Clinton, Acting Administrator of the Agency for Health Care Policy and Research [AHCPR). This agency is charged with conducting research that will enable us to enhance the quality and effectiveness of health care services, enhance access to appropriate health services, and disseminate information to health care providers.

AHCPR conducts medical treatment effectiveness research, health services research, rural health research, and technology assessment.

The budgets for medical treatment effectiveness research have taken big leaps over the past 3 years, jumping from under $6 million in 1989 to almost $63 million in 1991. The budget request for 1992 breaks this pattern, requesting_essentially level funding for this research. This is one area that I am very interested in, and I want to hear the agency's plans for this initiative in the area of medical treatment effectiveness research.

Dr. Clinton has been Acting Administrator since its creation. Again, Dr. Clinton, we welcome you to the subcommittee. Your full statement will be made a part of the record. Please proceed with your remarks.

Dr. CLINTON. Thank you, Mr. Chairman. Our written presentation outlines our request for $122 million for the coming fiscal year, about a 6-percent increase over the prior years, and provides considerable detail about the sources of financing and the various aspects of that program.

In my opening statement this morning I would like to focus on three things I think that we have particularly accomplished in the 16 months that the agency has been in existence.


First of all, we have created a new agency within the family of agencies in the Public Health Service and become the eighth in that family. We have brought in staff from basically every component of the Public Health Service. We have staff transferred from the Health Care Financing Administration, from GAO, and from the Veterans Administration. We bring an extraordinary wealth of experience and expertise to bear on the issues of health services and health systems research.

We have developed procedures and accounting systems that will serve us well as we proceed as a more proactive agency in the fu

ture. The National Advisory Council, which was established by the legislation, has been formed, functional statements created, and members selected. They have now met twice. They are prominent individuals in the field of health, nursing, allied health as well as health services research. They will provide a strong guiding hand in the work that we undertake.

Second, we have catalyzed several new programs. Our charge to develop an effectiveness and outcomes program is encapsulated in what we call the Medical Treatment Effectiveness Program. We have attached two diagrams at the back of our written statement which outline briefly the interaction between data development and research and guidelines, dissemination, and evaluation. We could comment on that later if you wish.

In addition, we have brought a great deal of energy to the area of primary care. This has been accomplished in various aspects of our agency and others within the Public Health Service but we believe it deserves a great deal more attention to highlight the issues of the underserved, access to care, and the dynamics that go on between patients and providers at the primary care level setting.

Third, we have energized the medical liability research activities within the Department. While these activities have been there in the past, the new authorization allowed us to take them into our charge. We have just completed a workshop conference to lay out our research agenda identifying key issues that we need to invest in to understand more clearly defensive medicine, alternative tort reform measures, and the other issues that compound this interaction between the legal system and today's medical system.

Finally, we have accomplished an extraordinary degree of collaboration. In the first instance, we have done that collaboratively with components of the Public Health Service. Our funds are transferred to other PHS agencies to accomplish actions within the Medical Treatment Effectiveness Program.

We have renewed relationships with the Health Care Financing Administration and made significant transfers of funds to accomplish needed data development activities to accomplish our effectiveness and outcomes agenda.

We have transferred money to the Health Resources and Services Administration and the Centers for Disease Control, to accomplish activities in which they have special expertise, consistent with the overall concepts of the Medical Treatment Effectiveness Program.

In the private sector we have accomplished a great deal. We have worked with the majority of major medical societies under the umbrella of the American Medical Association and with more than 40 groups under the American Nursing Association. We have brought in the allied health professionals into our set of activities for the first time both in terms of guideline development as well as research.


We are, then, the Department's focal point for health systems research and health services research. In its first 16 months we have both laid the groundwork and accomplished a significant amount of activity. We believe it will contribute to an improved quality health care system.

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