Page images

ASAHP requests Congress to appropriate the higher amounts listed in the more inclusive aforementioned categories.

More than 3,000,000 health care professionals comprise the allied health workforce (64 percent of all health care workers). They provide services in a comprehensive range of health care settings including hospitals, clinics, hospices, extended care facilities, HMOs, community programs, and schools. Allied health professionals share responsibility for the delivery of health care services including: prevention; identification and evaluation of diseases and disorders; health promotion; rehabilitation; health systems management; and dietary and nutrition services. The allied health professions include a wide range of disciplines such as audiology, dental hygiene, dietetics, EEG/EKG technology, medical record administration, clinical laboratory technology, nutrition, occupational therapy, physical therapy, radiologic technology, respiratory care, speechlanguage pathology, and surgical technology.

Serious allied health personnel shortages exist and are projected to become even worse. Compelling evidence is available to document the growing magnitude of the personnel shortage in allied health. Studies, surveys, and reports by groups such as the American Medical Association, American Hospital Association, U.S. Department of Veterans Affairs, National Institute on Aging, Medicare Prospective Payment Assessment Commission, U.S. Department of Health and Human Services, Health Departments and Trust Territories, and the Institute of Medicine of the National Academy of Sciences highlight the seriousness of a diminishing pool of allied health personnel and a worsening outlook for the future.

A combination of technological advances which increase the frequency of survival among those experiencing traumatic or severely disabling conditions and growth in numbers of persons with multiple chronic conditions living to advanced old age have led to an increased demand for health services. The allied health labor force has been unable to keep pace with these developments. Public and private interests have joined forces in many States such as Florida, Georgia, Illinois, Ohio, and Virginia to cope with the problem of inadequate supply of health care personnel. While strides have been made, it has become abundantly clear that conventional market forces alone are inadequate. Indeed, the only alternative for many providers is to enter into bidding wars for a scarce supply of personnel.

In summary, it is the belief of the American Society of Allied Health Professions and its Board of Directors that the Federal government should----as the largest consumer of health care- play a central role in partnership with State governments and private institutions in reducing shortages of allied health personnel. Furthermore, ASAHP believes that this role should encompass both attracting students (particularly from minority and underserved portions of the population) to academic allied health programs through the provision of entry-level traineeships and advanced programs that prepare allied health professionals for careers as academicians.



The American College of Preventive Medicine is the national medical specialty society of physicians whose primary interest and expertise is preventive medicine and public health. Our members work in public health agencies, in clinical medicine, in industry, and in academia. Many are board-certified in the specialty of preventive medicine. We are proud to offer the public a high degree of knowledge and skill in disease prevention and health promotion.

The American College of Preventive Medicine urges a greater allocation of our federal health dollars to prevention. In particular, we support increased funding for training physicians in preventive medicine, for training other public health professionals, and for the programs of the Centers for Disease Control.


Our nation's leaders in health have committed the country to achieving specific objectives in health promotion and disease prevention by the year 2000. However, we cannot do this without a cadre of well-trained professionals in our nation's health agencies, community-based organizations, private and non-profit institutions and industry. The institutions that produce these leaders are suffering, and cannot meet the needs for the public health workforce without more support.

Preventive Medicine is a medical specialty recognized by the American Board of Medical Specialties. It encompasses general preventive medicine, public health, occupational medicine, and aerospace medicine. Physicians trained in preventive medicine are the leaders in local and state efforts to preserve and promote good health. Working with large population groups, as well as with individual patients, they seek to understand the risks of disease, disability and death and to reduce or eliminate these risks.

There is a well-documented national shortage of physicians specializing in preventive medicine. Such a shortage was projected in 1980 by the the Graduate Medical Education National Advisory Committee (GMENAC). Since then, the HHS Council on Graduate Medical Education (COGME) and tho HHS Socretary's reports on the status of U.S. health personnel have consistently reaffirmed this shortage.

Many preventive medicine specialists receive their postgraduate training in preventive medicine residency programs. Nationally, there are 78 accredited residency programs. In 1989-90, a total of 513 physicians were being trained in these programs. This means that each year an average of about 170 such specialists complete their training.

This fiscal year, federal funds totalling $1.6 million were appropriated to support postgraduate training in preventive medicine. This sum has remained essentially unchanged for the last five years. In fiscal year 1991, these funds provided stipends for 53 residents in 11 programs. There are 67 other accredited residency training programas in the country that received no funding. For every slot available in these programs, there have been approximately four qualified applicants.

Why do we need federal subsidies for this training? Postgraduate education in preventive medicine is unlike that for any other medical specialty. Only the first year of training is in hospital-based clinical medicine, which is funded in the same way as any other first-year residency, through third-party reimbursement for services. However, the second year consists of academic work leading to a masters degree in public health or an equivalent degree. The third year is a practicum. The resident may participate in a broad range of clinical, research, and administrative activities, almost always in settings for which these activies are non-reimbursable. After their residency training, many of these physicians go on to practice in the public sector, where levels of compensation are appreciably lower than those available in other medical specialties.

Currently, residency programs scramble to put together funding packages for their residents. As the state, local and private funds used for this purpose have grown more and more sarco, the value of the meager federal funding in rcal dollars has decreased, Accordingly, we urge that the appropriation for preventive medicine residencies niso to $5 million. This is a modest sum indeed for such a crucial investment in the future of public health.

Occupational medicing is the specialty area of preventivo medicine concerned with health and safety in the workplace. The shortage of trained professionals in this field also is acute, the demand far exceeding the supply. The National Institute of Occupatwonal Safety and Hicalth (NIOSH) helps support a total of 39 university-based programs that offer much of the available professional education in occupational safety and health for physicians as well as other health professionals. Fourteen of these are regional Educational Resource Centers that offer multidisciplinary training. 25 others receive NIOSH training grants for single disciplines. Programs that train physicians also are accredited preventive medicine residencies.

These programs are losing students because of a lack of financial support. The NIOSH training budget that funds these programs has decreased from $120 million actual dollars in 1980 to about $10 million this year. This represents a decline of over 40% in real dollass. Therefore, we join these programs in urging you to appropriate a total of $130 million for NIOSH, including S114 5 million for research and $15.4 million for training. This will provide for a modest restoration of lost ground for occupational health training programs and a small expansion of research training

The training of public health professionals is closely linked to preventive medicine. The nation's 24 schools of public health provide training for physician specialists in preventive medicine as well as for many other health professionals who comprise our public health workforco. Socretary Sullivan reported in March 1990 thai, in addition to the shortage of physicians trained in public health and preventive medicine, there are shortages of epidemiologists, biostatisticians, environmental and occupational health specialists, public health nutritionists, and public health nurses.

In spite of these facts, the limited hut vilal federal support for public health training has been declining slowly since the early 1980s. We join with the deans of the schools of public health in requesting increased appropriations for three additional training programs under Title VII of the Public Health Service Act. For traineeships to support students that choose to enter carcers in short supply, we suggest $10 million. We ask an equal amount for special projects for curculum development in areas that address the federal health objectives for the year 2000. The Health Careers Opportunity Program, which supports recruitment of underrepresented minorities into the health field merits an increase from this year's $12 million to $40 million,


Physicians working in preventive medicine and public health rely heavily on the expertise and activities of the Centers for Disease Control, the nation's premier agency for disease prevention and health promotion. Therefore, we support, alongside many other organizations with a concern for prevention, a total CDC appropriation of $2 billion

Through funding of state and local programs, research, training, and surveillance, CDC has a major impact on every important issue in prevention. We concur with many of the prionlies for expansion that the Administration has proposed, including breast and cervical cancer prevention and control, immunization, AIDS, lead poisoning prevention, smoking, tuberculosis, and injury prevention and control. However laudable the proposed increases are, however, they are simply not enough. Compared to the billions that are spent on acute health care, our investment in prevention continues to lag. The frightening increases in health care costs we have witnessed are not a reason to cul back on funds appropriated for prevention. They are a reason to make a large investment now. Given the resources, CDC can play a critical role in revitalizing programs and services that we know will work to reduce death and disability in this country.



Mr. Chairman, and committee Members: My name is Jack Higgins. I greatly appreciate the opportunity to present this statement to the Subcommittee to discuss the need for support of the resources necessary to implement the Chief Financial Officers Act of 1990 ("CFO Act").

I am the Chairman of the Committee on Government Liaison of the Financial Executives Institute, a professional association of over 13,500 senior financial executives from 7,000 major companies throughout the United States and Canada.

Mr. Chairman, the CFO Act was passed by Congress as a step down the lengthy road toward federal financial management reform. The need for such reform is great. In testimony before Congress, Office of Management and Budget Director Richard Darman conceded that management problems in the federal government are enormous and that mismanagement could ultimately "affect the basis for confidence in democratic government." The budget crises facing the nation multibillion dollar deficits leaves the federal government little choice but to adopt responsible financial management policies.

Until the passage of the CFO Act, no one entity was solely vested with the responsibility for oversight of financial management practices in the federal government. Responsibility for this function was segregated among a number of Executive agencies and Congress. This resulted in fragmented oversight, at best, and negligible accountability relative to that normally found in most businesses. This deplorable situation exposed the government to even greater risks of waste, fraud, and abuse. with the federal government's total operating budget currently in excess of $1 trillion annually, we who are responsible for corporate financial management found this situation completely incomprehensible and intolerable.

Responding to these concerns, the Congress, in the last hours of the 101st Session, enacted the CFO Act. This new law provides broad statutory authority to officials responsible for financial management in the Office of Management and Budget and in 23 departments and executive agencies. The Act enjoyed strong bipartisan support in both the House and Senate, and the Administration has expressed a strong commitment to its implementation.


While the CFO Act creates new reporting responsibilities for the office of Management and Budget, the General Accounting Office, and individual Inspector Generals, it is the new responsibilities of the Executive agencies that I bring to your attention today: The new responsibilities of departments and agencies include the following.


The CFO Act directs that all 14 cabinet departments and nine major agencies shall have a Chief Financial Officer who shall report to the agency head. Department CFO's and the CFO's at EPA and NASA shall be appointed by the President and confirmed by the Senate and be at executive level IV. The remaining agency CFO's shall be appointed by the head of the agency and be career government servants.


Agency CFO's must possess demonstrated ability in general management and knowledge of and extensive practical experience in financial management practices in large governmental or business entities.

OMB is required to issue guidelines on how agencies should reorganize their financial management operations under the agency CFO. Upon receiving the guidelines from OMB, the head of each agency must submit a reorganization proposal to the Director of OMB. OMB has 60 days to approve or disapprove the proposal and notify the head of the agency.



Not later than June 30 of each year, each department and
agency shall prepare and have audited financial statements for
their revolving funds, trust funds, and commercial activities
for the preceding fiscal year. It also requires six
departments, two administrations, and two services to prepare
agency-wide financial statements on a test pilot basis. The
statements are intended to identify financial weaknesses and
vulnerabilities within agency operations. The statements and
audits for each agency shall be submitted to OMB which shall
submit a final copy of the reports to Congress.
Government Corporations are required to prepare financial
statements and audits each year. The corporations must also
submit an annual management report to Congress not later than
180 days after the end of their fiscal year.



Members of Financial Executives Institute's Committee on Government Liaison are very concerned about the level of resources directed to implement this new law. We have prepared the following suggested questions which we urge you to pose to agency heads under your Subcommittee's jurisdiction. We have also taken this opportunity to prepare elements of what we perceive to be the appropriate response by the departments.


Question: Has your agency identified a Chief Financial
officer and Deputy Chief Financial officer in accordance with
the CFO Act of 1990?

Suggested Response: By this time, all departments and
agencies should have identified Chief Financial Officers.

The CFO Act directs that departments and major agencies shall
have a Chief Financial Officer who shall report directly to
the agency head. Each of these CFOs will have a deputy who
shall be appointed by the head of the agency and have a
reserved position in the Senior Executive Service. Sixteen
of the 23 agency Chief Financial Officers are to receive
compensation at the executive level IV.


This new law was not seen as a vehicle to simply elevate current incumbents to a new senior level. Framers of the CFO Act envisioned the cabinet departments searching extensively for personnel with broad experience as a senior financial executive in a corporate or government setting. New offices should be developed separating the finance function from other administrative responsibilities of a federal agency. Additionally, the office of the CFO should have adequate manpower and budgetary support to successfully carry out its mission.

« PreviousContinue »