45 in the U.S.; 2) data about workplace injuries and illnesses; 3) major workplace health hazards and diseases; 4) a description of technologies for evaluation and control of occupational health and safety hazards; 5) supplemental tools for occupational safety and health (e.g., occupational medicine, epidemiology, education, and training); 6) the roles of OSHA and NIOSH; 7) an analysis of the impacts of OSHA standard setting and enforcement; 8) the uses and limits of economic analysis in decisionmaking for occupational safety and health; 9) strategies for control of workplace safety and health hazards; 10) reindustrialization and occupational safety and health; and 11) safety and health in the workplace of the future. Case Study Deliverables: 1) OSHA Health Inspection Data 2) The Role of Economic Analysis in Health and Safety Regulation 4) The Effects of the OSHA Lead Standard 5) Controls for Silica Exposure 6) The Cause, Diagnosis, and Treatment of Carpal Tunnel Syndrome Requested by: Senate Committee on Labor and Human Resources House Committee on Energy and Commerce Projected Delivery Date to TAB: January 1984 MEDICAL TECHNOLOGY AND COSTS OF THE MEDICARE PROGRAM The costs of the Medicare program have been rising rapidly, and medical technology is a prime component of this increase. The project will analyze a broad range of mechanisms to reduce or limit Medicare costs related to medical technology from changes in reimbursement mechanisms to control of particular technological services. Interim Deliverables The Effectiveness and Costs of Alcoholism Treatment (Case Study) (March 1983) Examines the evidence on alcoholism treatment in a variety of settings (in-patient care, out-patient hospital care, community based treatment centers, etc.) as well as the effectiveness of various methods of treatment (chemical aversion therapy, group therapy, and Alcoholics Anonymous). (Case Study published March 1983) (Requester: Senate Committee on Finance, Subcommittee on Health) The Implications of Variations in Length of Hospital Stay (Case Study) (August 1983) - Examines the evidence on how variations in length of hospital stay affect patient outcomes and the implications of changes in length of stay for quality of care, access, and Medicare/Medicaid program costs. (Requester: Senate Committee on Finance, Subcommittee on Health) 46 The Safety, Efficacy and Cost Effectiveness of Apheresis (Case Study) (July 1983) The conditions for which the benefits and risks of therapeutic plasmapheresis (a costly procedure which is being used to treat an increasing number of medical conditions) have been demonstrated were determined. (Requester: Senate Committee on Finance, Subcommittee on Health) Diagnosis Related Groups: Implications for Medical Technology (Technical Memorandum) (July 1983) This Technical Memorandum examines DRG's, their potential use in the Medicare payment system, and the potential impact on medical technology use. It also describes New Jersey's experience with diagnostic related groups, a method of prospective hospital reimbursement, and the cost implications for national implementation. (Requester: House Committee on Energy and Commerce, and the Subcommittee on Health and Environment) The Efficacy and Cost Effectiveness of Continuous Ambulatory Peritoneal Dialysis (CAPD) - This Case Study will assess the growing use of CAPD in terms of its costs, risks, and benefits. (Requester: Senate Committee on Finance) Requested by: House Committee on Energy and Commerce Projected Delivery Date to TAB: January 1984 FEDERAL POLICIES AND THE MEDICAL DEVICES INDUSTRY This assessment will fill some of the gaps in the basic information about the medical devices industry and analyze implications of alternative Federal policies. The study will develop information about the nature of firms that manufacture medical technologies, conduct case studies of selected medical devices, and examine present and proposed Federal policies that influence the medical devices industry and, in turn, the cost and effectiveness of medical devices. Interim Deliverables: Six medical devices have been selected for detailed case study: Boston elbow, contact lenses, hemodialysis equipment, nuclear magnetic resonance, technologies for managing urinary incontinence, and wheelchairs. These devices perform different functions in medicine (diagnosis, treatment, and rehabilitation) and relate to different areas of policy (research and development, patents, premarketing approval, third-party payment, and government procurement). In addition, a Technical Memorandum, Procurement and Evaluation of Medical Devices by the Veterans Administration, will examine the policies of the Veterans Administration regarding the evaluation and purchase of medical devices. The assessment will examine the status of biomedical and epidemiological research and related technology development in the area of tropical diseases. The traditional tropical diseases malaria, schistosomiasis, trypanosomiasis will be covered, as well as other conditions which, while not confined to the tropics, pose major public health problems in those areas. The natural history, epidemiology, and health effects of each disease will be described and the status of prevention, diagnosis, and treatment assessed. Contributions of the fast-moving fields of immunology and microbioloty will be highlighted. The role of development in the prevention and spread of disease will be included. The assessment will focus on the importance of tropical disease research to the U.S. population. It will analyze data on the diseases' prevalence, on the burden posed by them, and on sources and levels (both U.S. and foreign) of research funding. The assessment is being designed to define research priorities. It will examine the status of research and technology in the major disease areas, identify areas of promise for continued or increased funding, and present a series of options for making decisions about research funding, technology development and testing, and other policies regarding tropical diseases. In addition, the assessment will develop specific information on Gorgas Memorial Laboratory research areas and accomplishments. Tropical Disease Research and the Gorgas Memorial Institute (Technical Memorandum) (August 1983) OTA examined the quality and relevance of research at the Gorgas Memorial Laboratory (GML) in tropical public health. GML is the functioning unit of the Gorgas Memorial Institute of Tropical and Preventive Medicine, Inc., a private, non-profit, currently federally funded corporation. The Laboratory is located in Panama, and has operated since 1928. Requested by: Senate Committee on Appropriations Projected Delivery Date to TAB: January 1984 BLOOD POLICY AND TECHNOLOGY Technologies affecting the availability, uses, and risks of blood products will be assessed. New technologies will be assessed in the areas of (1) blood collection, processing, storage, and distribution; (2) identification, isolation, production, and use of blood components; (3) blood substitutes; and (4) identification and prevention of bloodtransmitted diseases and other risks. Improved health care and increased understanding of the physiology of aging, as well as applications of computers, robotics, and telecommunications in the home and workplace, may increase the independence, productivity, and quality of life for the aging American population. This study will assess the impact of technology on health, employment, housing, and long term care of the elderly. Impact of Neurosciences (Background Paper) A workshop was held at OTA on July 27 on the medical, scientific, social, and public policy implications of neuroscience. The workshop was composed of representatives from science, industry, executive agencies, and other concerned individuals. Many representatives from executive agencies and Congressional Committees and Members personal staffs also participated. This workshop provided valuable input for the final draft of a Background Paper that will be published in 1984. Requested by: Senate Special Committee on Aging House Select Committee on Aging House Committee on Education and Labor (endorsement) Projected Delivery Date to TAB: April 1984 ALTERNATIVES TO ANIMAL USE IN TESTING AND EXPERIMENTATION Approximately 70 million animals are used annually for both toxicity testing and biomedical and behavioral research. In a large percentage of cases, these animals are killed during the course of, or following the completion of, the experimental protocol. Toxicity testing and biomedical and behavioral research are two very distinct disciplines, and animal use and its possible alternatives must be examined in light of their differences. This assessment will examine the current patterns of acquisition and use of animals in the distinctly different disciplines of toxicity testing and biomedical and behavioral research. In addition, the feasibility and cost of developing technologies that could potentially substitute for animals in either of these areas will be evaluated. Since toxicity testing employs about 20 percent of all laboratory animals used annually, OTA will also analyze regulatory testing requirements in both the United States and selected foreign countries to determine whether they can be made more uniform in their 49 Finally, this study will briefly summarize the ethical issues concerning animal use in order to help understand the reasons for the current controversy. - The objectives of this assessment will be to: (a) assess trends and the state of R&D in computerized manufacturing technologies over this decade; (b) assess the development of industries producing computerized manufacturing equipment, software, and services; (c) assess the potential utility of computerized automation for various categories of manufacturing industries that might use it; (d) assess impacts on employment job loss, job creation, job redefinition; new skill needs; and workplace quality; (e) assess implications for education and training, for general technological literacy, for specialized vocational skills, and for scientific and engineering expertise; and (f) analyze the impacts of Federal policy options on the development and use of computerized automation systems in U.S. manufacturing. Automation and the Workplace: Selected Labor, Education, and Training Issues (Technical Memorandum) (Requesters same as for full assessment) Discusses concepts for evaluating the impacts of manufacturing automation, and describes the conduct of education, training, and retraining for persons seeking or holding jobs in manufacturing industries. Requested by: Senate Committee on Commerce, Science and Transportation Senate Committee on Labor and Human Resources Joint Economic Committee House Committee on Education and Labor House Committee on Science and Technology Projected Delivery Date to TAB: January 1984 EFFECTS OF INFORMATION TECHNOLOGY ON FINANCIAL SERVICES SYSTEMS The objectives of the assessment are to: (a) describe the current status of the financial services industry, (b) forecast the technologies that may be used for delivery in financial services, (c) analyze the potential impacts of the applicable technologies on the evaluation of the financial services industry, (d) identify the mechanisms through which policy relative |