Senator HARKIN. Thank you very much for an excellent statement. I agree with everything you have said. It does save money and it saves lives. It is good to hear your testimony. You requested funding for contraceptive research. Do you have a figure on that at all? Ms. BRECKENMAKER. I do not have a figure on the exact dollar amount, but obviously, as you know, Norplant is the first new contraceptive method we have had in many, many years in this country. What I have heard some folks say is that Third World countries have better access to new methods than we do here in the United States. But we can certainly get that dollar amount for you. Senator HARKIN. How is the Norplant contraceptive impacting family planning clinic budgets? Ms. BRECKENMAKER. Right now, Norplant, in fact, in my area, I cover 24 counties of central Pennsylvania, mostly rural areas, there are many woman who would be very interested in the Norplant method. However, the cost of Norplant is outrageous, as I am sure you have heard. Senator HARKIN. How much is it? Ms. BRECKENMAKER. It is somewhere in the neighborhood of $350 just for the Norplant itself. And the insertion is estimated at another $150. So we are talking about an average of about $500 per patient. For a poor woman, it is absolutely not accessible. What we are working on right now, in fact, we are doing estimates in our council. Just thinking of $25,000, which sounds like a lot of money in central Pennsylvania in 24 counties, it would only provide this service to 50 woman. And it is a crime. The good news is that many States are approving this method to be funded through Medicaid. So that does take care in some instances of medical assistance patients. However, there is a large number of patients, as you well know, between the fee payer and the medical assistance patient. And the title X program takes care of most of those women. However, we have not had an increase in many, many years at least not in line with inflation. Today, our funding should be somewhere in the neighborhood of $239 million if we had stayed within inflation. And what we are asking for today is $180 million at least. But basically Norplant is causing some very serious questions in our program. Ms. JUNE. The bitter irony, Senator Harkin, with Norplant is, and in Iowa we have done research on delivery on how to make this new contraceptive method available to the women in Iowa, but the bitter irony is that this first new contraceptive method available now is more expensive to women than an abortion is. And that simply is unjustifiable. Senator HARKIN. That is a good point. Ms. JUNE. I sat here all this morning listening to the testimony and you know that for many years I worked with disabled children, children in day care, foster care, and I purposely left that career and came into family planning in Iowa because I wanted to do what I thought was the most moral preventative act possible. And that was help women plan the birth of their children. The year that I came in to the family planning program, the Federal budgets were slashed for family planning by more than 25 percent. And I sit here a dozen years later still not looking at that funding level from those early days. It strikes me after listening to the testimony this morning that the family planning request to this subcommittee and to Congress are incredibly moderate. These are modest dollars that we are asking for that promises to deliver great economic advantage for those individual families in particular, for the Federal Government. More importantly, the humane aspects of this program are really unparalleled. Senator HARKIN. Thank you both. Jill, I have known for a long time and she is always a great spokesperson for Family Planning and Reproductive Health. It is good to see you again. Thank you both for being here again. This is a high priority of this subcommittee, and of this Senator, I can assure you. Thank you very much. STATEMENT OF SUSAN SCOTT, THE NATIONAL REHABILITATION CAUCUS Senator HARKIN. Next is Susan Scott representing the National Rehabilitation Caucus. Welcome to the subcommittee. Your statement will be made a part of the record in its entirety. Ms. SCOTT. Thank you for the opportunity, Senator Harkin, to be here on behalf of the National Rehabilitation Caucus. We are a coalition of organizations representing health care professions, consumers, and institutional home and community-based providers of medical rehabilitation services. The purpose of our testimony this morning is to urge the subcommittee to support appropriations necessary for the funding of allied health education and training initiatives authorized under title VII of the Public Health Service Act. It is also to thank you and members of the subcommittee for your support of allied health education in the past. However, Mr. Chairman, the country continues to face serious shortages of medical rehabilitation professionals. I believe you heard this from earlier witnesses this morning. Hospitals, nursing facilities, home health, and rehabilitation agencies and other service providers are increasingly unable to recruit sufficient numbers of qualified occupational therapists, physical therapists, respiratory therapists, speech/language pathologists, and other medical rehab professionals to provide essential services. The skills and services of these professionals are especially important in the provision of care to the elderly, the chronically ill, and people with disabilities. The personnel shortages in these professions are going to intensify in the years ahead unless congressional action is forthcoming to assure the availability of an adequate number of these people. A recent study by the American Hospital Association conducted among hospitals nationwide reveals for the second year in a row serious difficulties recruiting and retaining medical rehabilitation professionals. The highest staff vacancy rates nationally are 16.4 percent for physical therapists and 13.6 for occupational therapists. Other professions classified as personnel shortage categories include speech/language pathologists at 9.9 percent and respiratory therapists at 8.9 percent. Mr. Chairman, numerous other studies which are described in our full statement have revealed the same problem. Studies by the Medicare Perspective Payment Commission, the VA, the Department of Health and Human Services, the Institute of Medicine, the Administration on Aging, just to name a few, all underscore the shortage of rehabilitation personnel and the problems associated with it. This year Congress will be reauthorizing the title VII health profession's training programs for fiscal year 1992 and subsequent years. The rehabilitation caucus is urging authorization of $24 million in fiscal year 1992 for title VII allied health initiatives. We strongly urge this subcommittee to consider full funding at whatever levels are ultimately authorized. Our specific recommendations are: $7 million to assist in the development, expansion, and improvement of allied health education programs; $7 million for programs to increase the availability of qualified faculty, which is a big problem for us; $10 million in direct student assistance. PREPARED STATEMENT We further urge that in light of limited resources, funds appropriated be targeted to those professions that have substantial shortages and which play a significant role in the care and rehabilitation of the elderly and people with disabilities. With this targeted effort we can begin to address the most serious existing shortages and position ourselves to meet the health care requirement of those rapidly growing segments of our population who are most in need of medical rehab services. Again, Senator Harkin, on behalf of the National Rehab Caucus, I thank you for this opportunity to share our views on this important issue. [The statement follows:] STATEMENT OF SUSAN SCOTT Mr. Chairman and Members of the Subcommittee: On behalf of the National Rehabilitation Caucus, a coalition of organizations representing health care professionals, consumers and institutional, home and community-based providers of medical rehabilitation services, I want to express our appreciation for the opportunity to appear before you today. The purpose of our testimony this morning is to urge the Subcommittee to support appropriations necessary for the funding of allied health education and training initiatives authorized under Title VII of the Public Health Service Act. As you know, Mr. Chairman, the nation continues to face serious shortages of key medical rehabilitation professionals. Hospitals, nursing facilities, home health and rehabilitation agencies and other service providers are increasingly unable to recruit sufficient numbers of qualified occupational therapists, physical therapists, respiratory therapists, speechlanguage pathologists and other medical rehabilitation professionals to provide essential services. The skills and services of these practitioners are critically important in the provision of care to the elderly, the chronically ill and individuals with disabilities. The personnel shortages in these professions will intensify in the years ahead unless concerted effort is forthcoming to assure the availability of an adequate number of practitioners. The most recent American Hospital Association (AHA) human resource survey conducted among hospitals nationwide reveals, for the second year in a row, serious difficulties recruiting and retaining medical rehabilitation professionals. The highest staff vacancy rates nationally are 16.4 percent for physical therapists and 13.6 percent for occupational therapists. Other professions classified as personnel shortage categories include speech-language pathologists (9.9 percent) and respiratory therapists (8.9 percent). These shortages are being experienced by rural and urban hospitals alike. Vacancy rates in many individual states have reached such serious levels that hospitals are responding by reducing services, closing beds or units and diverting patients to other facilities when medically appropriate. These staff shortages are also confirmed in a staff study conducted by the Prospective Payment Assessment Commission (ProPAC). The U.S. Department of Veterans Affairs (VA) medical system is The U.S. Department of Health and Human Services' 1990 Annual Report to Additional reports from the Institute of Medicine, the U.S. Department of Education, the Institute on Aging, and others all underscore the growing threat these shortages represent to our nation's ability to provide important health and rehabilitation services. A principle factor contributing to these shortages is the escalating demand for services from a population with more individuals surviving into old age, frequently with chronic conditions or multiple disabilities. According to the 1990 HHS report, "As the number of elderly increases, the demand for allied health practitioners in a variety of fields will rise accordingly, and combined with greater longevity will have a significant impact on demand for practitioners in rehabilitation fields such as occupational therapy, physical therapy, respiratory therapy and audiology." Further, advancements in medicine and technology have increased the frequency of survival from accidental trauma or severely disabling conditions present at birth, thereby heightening demand for services to enhance functional independence and quality of life. Future projections illustrate the need for Congress to take action now if a crisis in health care is to be averted in the years ahead. The National Academy of Sciences' Institute of Medicine, in a major study conducted in 1988, noted that unless Federal policymakers intervene the nation will suffer from a "serious shortage of allied health professionals". More specifically, the IoM projected that the most serious personnel shortages by the year 2000 could occur in the fields of occupational and physical therapy. U.S. Department of Labor estimates lend further credence to this warning. Projections by the Bureau of Labor Statistics indicate that between now and the turn of the century, the nationwide demand for physical therapists and occupational therapists will increase by 57 percent and 49 percent respectively, with 34 percent increases for speech-language pathology and respiratory therapy, and similar increases for other allied health professionals. In addition to significantly increased demand for services, a serious lack of focused Federal support for the education and training of allied health professionals generally, and medical rehabilitation professionals specifically, has compounded the personnel shortages currently being experienced. While historically the Title VII health professions programs represented the primary source of Federal support for the training of allied health professionals, funding for these programs ended after 1980. Some modest initiatives to redress this situation were enacted when Congress reauthorized the Title VII programs in 1988. However, annual authorization levels targeted to allied health totaled only $6 million, and appropriations over the three year period totaled $2.3 million. The educational system for rehabilitation professionals has not been able to meet the surging demand. This inability to produce an ample supply of qualified practitioners is caused by a variety of factors including an inadequate supply of faculty, an inability to increase class sizes because of a lack of resources, a shortage of education programs in some professions, and a decrease in funds for scholarships to attract students into programs. Mr. Chairman, Congress will be reauthorizing the Title VII health professions training programs this year for fiscal year 1992 and subsequent years. The Caucus is urging authorization of $24 million in FY 92 for Title VII allied health initiatives and we strongly urge this Subcommittee to consider full funding at whatever levels are ultimately authorized. Our specific recommendations are as follows: Allied Health Project Grants and Contracts (796) - $7 million to assist in the development, expansion and improvement of allied health education programs. Traineeships for Advanced Training (Section 797) $7 million for the development of post-graduate programs and traineeships to increase the availability of qualified faculty. Entry Level Traineeships (proposed) $10 million for entry level assistance to attract additional students into shortage fields or specialties. We further urge that, in light of limited resources, funds appropriated be targeted to those professions that have substantial shortages and which plan a significant role in the care and rehabilitation of the elderly and persons with disabilities. With this targeted effort we can begin to address the most serious existing shortages and position ourselves to meet the health care requirements of those rapidly growing segments of our population most in need of medical rehabilitation services. Again, Mr. Chairman, on behalf of the National Rehabilitation Caucus, I thank you for this opportunity to share our views on this important issue. |