(Circulation. 2000;101:e9031.)
© 2000 American Heart Association, Inc.
Cardiovascular News |
Medicare Trust Fund Solvency
The Medicare Hospital Insurance trust fund is expected to remain solvent until the year 2023, according a report issued by the fund’s trustees on March 30, 2000.
This estimate, which is based on the most current economic and demographic data assumptions, extends the fund’s projected solvency by 8 years over what had been projected by the trustees last year. The projection for the length of time the fund will remain solvent is the longest since 1974.
The robust national economy and fewer expenditures because of the federal Health Care Financing Administration’s renewed cost-cutting measures were credited with extending the life of the fund and with cutting the projected 75-year actuarial deficit by >75%.
"This is a remarkable accomplishment considering that when this Administration took office, the trust fund was projected to be depleted in 1999. In the 7 years since the Clinton Administration took office, we have extended the life of the trust fund by a full 24 years and cut the long-range actuarial deficit by 75%," said Health and Human Services Secretary Donna E. Shalala.
However, the trustees did express concern about increases in long-term costs to the Supplemental Medical Insurance trust fund (Medicare part B) that helps pay for the services of physicians and other healthcare professionals, outpatient hospital services, and home health care and other services. The program is financed by general revenues from the government and by monthly premiums paid by beneficiaries. The report issued by trustees called on Congress to exert control over those costs before the baby boom generation reaches retirement age.
Government Accounting Office Charges Health Care Financing Administration Lost $212 Million on Settlements
The Health Care Financing Administration (HCFA) collected only $120 million of debts that exceeded $332 million—a reduction that resulted from the negotiated settlements of large overpayments to 3 Medicare providers, according to an official in the Office of Special Investigations in a report to the Permanent Subcommittee of the Investigations Committee on Government Affairs of the US Senate in March 2000.
Robert H. Hast, acting assistant comptroller general for special investigations in the Office of Special Investigations of the Government Accounting Office (GAO) said that the payments represented only 36% of the total principal owed by the 3 healthcare entities. He said his agency had analyzed 96 agreements reflecting the Medicare overpayment settlements negotiated by the HCFA between 1991 and 1999. Nothing improper was found in 93 of the agreements. "We did determine, however, that the HCFA acted inappropriately in several respects in the 1995, 1996, and 1997 settlements of the 3 largest matters," he said in testimony presented to the committee. A transcript of the testimony is available on the GAO Website at http://www.gao.gov.
Mr Hast said that the participation of the former HCFA administrator, Bruce Vladek, in the largest settlement raised concerns of conflict of interest. In addition, the agency did not obtain Department of Justice approval of the settlement, it disregarded permissible settlement criteria established by regulation, the settlements had questionable provisions, and they were executed without the benefit of legal counsel. Mr Hast said that Mr Vladek had prior professional associations with 2 of the 3 providers immediately before being appointed HCFA administrator. HCFA regulations require that all settlements >$100,000 must be referred to the Department of Justice; however, the agency did not do so in these 3 instances, nor did it refer the matters to its own general counsel.
The chronology of the 3 settlements and the GAO’s analysis of them is contained in the agency’s report from February 25, 2000.
Smallpox Vaccine Testing
Researchers at the St Louis University School of Medicine’s Center for Vaccine Development have been asked to determine the safety and effectiveness of the remaining supplies of the smallpox vaccine Dryvax. The request from the US Centers for Disease Control and Prevention in Atlanta was made because of fears that the deadly viral disease could be spread or revived through terrorist attacks.
Smallpox is considered officially eradicated because of mass vaccinations programs worldwide, but the World Health Organization balked at destroying remaining stores of the virus because of fears of bioterrorism. The stocks, which are kept in high-security laboratories at the Centers for Disease Control in Atlanta and at the Russian State Center for Research on Virology and Biotechnology in Novosibirsk, were to have been destroyed June 30, 1999. Both the United States and Russia were among 30 nations at the annual assembly of the World Health Organization last May who sponsored a resolution calling for more international research into antiviral agents and improved vaccines. Determining if the vaccines on hand can protect against the disease is the first step to developing protection against bioterrorism.
The Missouri researchers will enroll 60 people in the study. Twenty
people will receive the vaccine diluted 10 times, 20 will receive the
vaccine diluted 100 times, and the remaining 20 will get the vaccine in
its full undiluted dose. Experts estimated that 
7 million doses of
the vaccine are now available in the United States—far too few to
protect the entire US population. Being able to dilute the vaccine
would increase the available dosages immediately.
At the same time, military and government scientists are looking for ways to develop other vaccines against the disease. Diluting the currently available vaccine would only be a stopgap measure until those efforts bear fruit, officials said.
Need for Better Maternity Leave Policies Voiced
A meta-analysis of 29 observational studies of 160 000 working women found that physically demanding work was significantly associated with preterm birth, maternal hypertension, and infants who are small for their gestational age. The University of Michigan Health System researchers said the findings, which were published in the April issue of Obstetrics and Gynecology, demonstrate the need for a better national maternity leave policy (Obstet Gynecol. 2000;95:623–636).
In this study, the authors found that prolonged standing, shift work, and work fatigue were associated with preterm birth. However, long hours were not associated with prematurity.
"Activities that women engage in at work do affect their pregnancy outcomes," said Ellen Mozurkewich, MD, a fellow in the division of maternal-fetal medicine in the University of Michigan Health System and the study’s principal investigator. "Employers should either be willing to allow their pregnant employees to modify their work-related activities or they should provide longer leave time for pregnant women." The United States is one of the very few industrialized countries that does not mandate paid maternity leave and health benefits.
In the past 40 years, the number of working women has nearly tripled, and pregnant women now work later in their pregnancies. Between 1961 and 1985, the number of women working to within 1 month of delivery has more than doubled. In recent years, the number of problem pregnancies has also increased. "Between 1985 and 1996, the incidence of low birth weight rose from 6.8% to 7.4%, while preterm births rose from 8.8% in 1980 to 11% in 1996," said Dr Mozurkewich.
"This is a major issue for obstetricians and working women who are pregnant," she said. "Although it seems very straightforward to modify the work environment for women who are pregnant, a lot of employers don’t have a mechanism to do that."
Human Genome Is Two-Thirds Complete
The Human Genome project is two-thirds complete, and researchers think they can complete a "working draft" of the genetic blueprint by June. The international consortium includes 3 health centers in the United States (designated by the National Human Genome Research Institute), genome researchers with the US Department of Energy, the Sanger Institute in Britain, and French scientists; it has sequenced 2 billion of the 3 billion base-pairs that make up the human genome.
"It took 4 years to sequence the first billion base pairs, but only 4 months for the second billion," said Dr Richard Gibbs, director of the Human Genome Sequencing Center at Baylor College of Medicine in Houston. "At such a rapid pace of discovery, we should be able to finish a draft of the genome over the next 3 months." The other 2 designated centers are the Massachusetts Institute of Technology and Washington University in St Louis, Mo.
Scientists with the Human Genome Project deposit their data into GenBank, a public database of DNA sequences operated by the National Institutes of Health. This information is accessible, free and without restrictions, to all scientists in industry and academia.
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||