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all Institutes within the NIH. The NICHD has consistently funded the lowest percentage of competing grants per year, and with the least dollars awarded per each grant funded among the seven major Institutes within the NIH.

For the NIH as a whole, the Society for the Study of Reproduction supports the recommendation of the Ad Hoc Group for Medical Research Funding. We support a budget of $9.77 billion for the NIH for FY 1992. This budget would increase the success rate of competing grants from 26.4% under the President's Budget to approximately 33% for the overall NIH. The budget of $9.77 billion for the NIH for FY 1992 would also permit the maximal-performance funding of both competing and noncompeting grants funded by the NIH during FY 1992.

The level of funding for the NIH including the NICHD would do much to stem the flow of scientists from the biomedical sciences. It would also greatly encourage young people to enter into the biomedical sciences as a career choice. The budget proposal of the President would only serve to continue to discourage biomedical research as a scientific discipline. If we wish America to be a strong and vital center for advances in biomedicine throughout this decade and into the next century, the time for action is now. The decision is yours, and I hope that you will support in appropriations what I have proposed to you.

Thank you for your consideration of our request.



The American Fertility Society (AFS), an organization of 10,500 physicians and scientists interested in reproductive medicine, is pleased to submit a written statement for the record on the President's proposed fiscal year (FY) 1992 budget for the National Institute of Child Health and Human Development (NICHD). Among NIH Institutes, the NICHD has consistently had one of the lowest funding rates when measured by success rate


- the ratio of applications funded to applications reviewed. Under the President's proposed budget request of $520,584,000 for FY 1992, shortfalls in funding for the Institute will continue. Our organization joins other friends of NICHD in recommending an appropriation of $702,375,000 for FY 1992, the Institute's professional judgment budget. Although we recognize the budget constraints facing the Congress, we believe that this figure would alleviate current budget constraints within the Institute and allow the NICHD to more effectively carry out its programs of research. NICHD is involved in many important research projects affecting maternal and child health, however, our comments will focus on the five contraceptive and infertility research centers established by the Congress last year. The American Fertility Society wishes to thank you for recognizing the importance of research in these areas.

Last March, the NICHD issued Request for Applications (RFA) for the development of two infertility research centers and three contraceptive research centers. These five centers will represent cooperative agreements between the NICHD and outside investigators. These multidisciplinary centers are designed to link basic research and clinical investigation, thus shortening the time that treatments for infertility and new methods of contraception can reach the American public.

The RFA for the infertility research centers focuses on the medical assisted alleviation of infertility and consists of three general phases over a five-year period: development of a protocol, conduct of research and analysis of results, and dissemination of results or addition of future studies. Infertility is defined as the inability of a couple to conceive after 12 months of intercourse without contraception and affects 2.3 million American married couples in the United States according to the National Center for Health Statistics. These two centers are expected to be oriented toward research on the early diagnosis and/or therapy of the female factors that most often contribute to infertility or those male factors associated with ineffective sperm production. The NICHD would like to fully fund these five centers at $6 million in FY 1992. They are unable to do so under the President's proposed budget request.

The contraceptive research centers will conduct comprehensive preclinical and clinical research on the development of new contraceptive products. According to the RFA, each applicant is requested to submit a minimum of three distinct fundable projects representing a mix of research activities. For FY 1991, the contraceptive research centers are funded at $2 million or approximately $700,000 per center. This amount represents minimal core activities. Additional funding in the out years is essential to support the longterm goals of this program.

In conclusion, the American Fertility Society urges you to accept the professional judgment budget of $702,375,000 for FY 1992 which includes $6 million for full funding of the contraceptive and infertility research centers and also allows full funding of other research programs at the Institute. We thank you for your strong commitment to the NICHD in the past and know that we can count on you in the future.


Mr. Chairman and members of the Subcommittee

My name is Gary Filerman and I am President of the Association of University Programs in Health Administration, a consortium which includes 53 U.S. graduate schools with a network of collaborating health services foundations, business organizations, and government agencies. Our primary mission since the time the Association was founded back in 1948 has been to focus the resources of higher education on a single goal: managing health services with optimum quality, efficiency, and responsiveness.

Mr. Chairman, perhaps the most critical challenge confronting our health care system today is the coordination and management of a system that will cost-effectively serve the health needs of all citizens. And never has that challenge been so great.

For in spite of more than a decade of intensive efforts to curb health care costs, medical spending by Americans continues to grow faster than the rate of inflation. At the same time, we are seeing an explosion of new types of health care organizations--such as HMOs and PPOs--which emphasize prevention, primary care, and low-cost alternatives to traditional health care systems.

Unfortunately, many of the efforts that have been undertaken to control rising costs and find more cost-effective methods for meeting America's health service needs have met with only limited


Why? In large part because these efforts outrun the management capabilities of the very system they are intended to help.

The fact is that nearly every aspect of health care policy-from assessing expensive new technologies to AIDS patient management to dealing with nursing shortages--is ultimately the responsibility of health services administrators. Administrators must create the conditions under which physicians, nurses, and other health professionals are most productive by drawing together the needed resources, while making sure that quality and cost control systems function properly.

Whether or not they are up to the task will in large measure determine the success or failure of new federal policies where it counts--in the community.

The sad fact is that management competence in health services is grossly uneven.

As critical as these positions are to our health care system, we know that as many as two-thirds of the nation's health services administrators lack the professional management skills

needed to deliver quality health services on an equitable and cost-effective basis. And while some may argue that there is an oversupply of health professional, quite the opposite is true when it comes to health services administrators.

There are in fact extremely serious management shortages in HMOS, emergency medical systems, nursing homes, home health agencies, community health centers, and rural hospitals. In fact, while the Department of Health and Human Services seeks to terminate funding for Health Administration, another arm of the government--the U.S. Department of Labor--has designated health services administration as the area with the largest unmet need of the decade.

From a practical standpoint, what does all this mean?

It means that whatever steps you and your colleagues here in Congress take to contain costs or improve services will be limited by managers' inability to effectively implement federal policies.

It means that physicians and other health professionals will not be fully productive because the settings in which they practice will not be properly managed.

It means that any efforts you in Congress make to achieve equity in rural or inner-city health facilities will be hampered, thereby discouraging practitioners who might otherwise be motivated to serve there.


Mr. Chairman, while our Association strives to operate the highest quality university programs we can, the federal government must assume its responsibility as well. without appropriate management competence, no enterprise as large or as important as this country's health care system can operate effectively. To date, the modest federal investment has served as a catalyst in generating matching funds from universities and other sources. Each year the federal dollars you have appropriated have attracted resources well beyond the statutory matching requirements.

Our Association recommends that for fiscal 1992 Graduate Programs in Health Administration be funded at $3 million and that Health Administration Traineeships be appropriated $1.5 million. Thank you Mr. Chairman. I would be happy to answer any questions you have.


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