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Government Spending on Health Care Benefits and Programs: A Data Brief

Description: In a country where health spending accounts for more than 16% of gross domestic product (GDP), health care costs and spending are often described as a problem for consumers and their families; for employers that provide (or seek to provide) health benefits; and for government, which finances a mix of health care services, health research and training, and health safety programs. To describe government spending on health care benefits and programs, this report presents data from the Office of Management and Budget (OMB), the Congressional Budget Office (CBO), and the Centers for Medicare and Medicaid Services (CMS).
Date: June 16, 2008
Creator: Jenson, Jennifer
Partner: UNT Libraries Government Documents Department

Dental Manpower in the United States

Description: This report discusses the number of dentists in the U.S. and their ratio in proportion to the population as well as distribution across the U.S. Educational initiatives, funding programs, and other actions to alleviate a shortage of dentists are discussed.
Date: September 16, 1970
Creator: Kline, Janet
Partner: UNT Libraries Government Documents Department

A Comparative Analysis of Private Health Insurance Provisions of H.R. 3962 and S.Amdt. 2786 to H.R. 3590

Description: This report compares many of the private health insurance provisions of H.R. 3962 and the Senate Amendment. For each of the major private health insurance reforms, the report first gives a narrative description of the context and current law, then describes where H.R. 3962 and the Senate Amendment make similar reforms and how their approaches differ.
Date: December 16, 2009
Creator: Peterson, Chris L.
Partner: UNT Libraries Government Documents Department

Consumer-Directed Health Plans: Health Status, Spending, and Utilization of Enrollees in Plans Based on Health Reimbursement Arrangements

Description: A letter report issued by the Government Accountability Office with an abstract that begins "Consumer-directed health plans (CDHP) combine a high-deductible health plan with a tax-advantaged account, such as a health reimbursement arrangement (HRA), that enrollees can use to pay for health care expenses. In an effort to restrain cost growth, several employers, including the federal government through its Office of Personnel Management (OPM), have offered HRAs for several years. For enrollees in HRAs compared with those in traditional plans such as preferred provider organization (PPO) plans, GAO assessed (1) differences in health status, and (2) changes in spending and utilization of health care services. GAO analyzed data from two large employers--one public and one private--that introduced an HRA option in 2003. GAO compared changes in health spending and utilization before and after 2003 for enrollees who switched from a PPO into an HRA (the HRA group) with those who stayed in a PPO (the PPO group). At the time GAO made its data requests to each employer, 2007 data from the public employer and 2005 data from the private employer were the most current and complete data available. GAO also reviewed published studies that included an assessment of the health status, spending, or utilization of HRA and other CDHP enrollees compared with traditional plan enrollees. Results are not generalizable beyond the enrollees, health plans, and employers GAO reviewed and also cannot be compared between the public and private employers."
Date: July 16, 2010
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Workplace Safety and Health: OSHA Can Better Respond to State-Run Programs Facing Challenges

Description: A letter report issued by the Government Accountability Office with an abstract that begins "State-run programs face several challenges that primarily relate to staffing, and include having constrained budgets, according to OSHA and state officials. States have difficulty filling vacant inspector positions, obtaining training for inspectors, and retaining qualified inspectors. Recruiting inspectors is difficult due to the shortage of qualified candidates, relatively low state salaries, and hiring freezes. Although OSHA has taken steps to make its courses more accessible to states, obtaining inspector training continues to be difficult. According to an agency official, OSHA's Training Institute faces several challenges in delivering training, including recruiting and retaining instructors, difficulty accommodating the demand for training, and limitations in taking some courses to the field due to the need for special equipment and facilities. These challenges are further exacerbated by states' lack of travel funds, which limit state inspectors' access to OSHA training. Retaining qualified inspectors is another challenge among states. Officials noted that, once state inspectors are trained, they often leave for higher paying positions in the private sector or federal government. GAO's survey of the 22 state-run programs that cover private and public sector workplaces showed that turnover was more prevalent among safety inspectors than health inspectors. Nearly half of these states reported that at least 40 percent of their safety inspectors had fewer than 5 years of service. In contrast, half of the states reported that at least 40 percent of their health inspectors had more than 10 years of service. These staffing challenges have limited the capacity of some state-run programs to meet their inspection goals."
Date: April 16, 2013
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Clinical Data Registries: HHS Could Improve Medicare Quality and Efficiency through Key Requirements and Oversight

Description: A letter report issued by the Government Accountability Office with an abstract that begins "Clinical data registries (CDR) have demonstrated a particular strength in assessing physician performance through their capacity to track and interpret trends in health care quality over time. Studies examining results reported by several long-established CDRs demonstrate the utility of CDR data sets for analyzing trends in both outcomes and treatments. CDR efforts to improve outcomes typically involve a combination of performance improvement activities including feedback reports to participating physicians, benchmarking physician performance relative to that of their peers, and related educational activities designed to stimulate changes in clinical practice. Studies GAO reviewed provided less insight on ways to improve the efficiency of care."
Date: December 16, 2013
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Food Stamp Program: Farm Bill Options Ease Administrative Burden, but Opportunities Exist to Streamline Participant Reporting Rules among Programs

Description: A letter report issued by the Government Accountability Office with an abstract that begins "Many individuals familiar with the Food Stamp Program view its rules as unnecessarily complex, creating an administrative burden for participants and caseworkers. In addition many participants receive benefits from other programs that have different program rules, adding to the complexity of accurately determining program benefits and eligibility. The 2002 Farm Bill introduced new options to help simplify the program. This report examines (1) which options states have chosen to implement and why, and (2) what changes local officials reported as a result of using these options. Selected results from GAO's web-based survey of food stamp administrators are provided in an e-supplement to this report, GAO-04-1058SP. Another e-supplement, GAO-04-1059SP, contains results from the local food stamp office surveys."
Date: September 16, 2004
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Federal Funds: Fiscal Year 2001 Expenditures by Selected Organizations Involved in Health-Related Activities

Description: Correspondence issued by the General Accounting Office with an abstract that begins "This report responds to a Congressional request that we provide information on expenditures of federal funds by several organizations and their affiliates--the Planned Parenthood Federation of America, the Population Council, the International Planned Parenthood Federation, The Alan Guttmacher Institute, Advocates for Youth, and the Sexuality Information and Education Council of the United States (SIECUS)--all of which are involved in health-related activities. Specifically, we identified (1) fiscal year 2001 expenditures of federal funds that supported the domestic health-related activities of the organizations, the federal agencies that provided the funds, and the congressional committees with jurisdiction over legislation authorizing or appropriating the federal funds, and (2) fiscal year 2001 expenditures of federal funds that supported the international health-related activities of the organizations, the federal agencies that provided the funds, and the congressional committees with jurisdiction over legislation authorizing or appropriating the federal funds. This information updates our November 13, 2001, report that provided expenditure information for fiscal years 1999 and 2000."
Date: May 16, 2003
Creator: United States. General Accounting Office.
Partner: UNT Libraries Government Documents Department

VA and Defense Health Care: Progress and Challenges DOD Faces in Executing a Military Medical Surveillance System

Description: A statement of record issued by the General Accounting Office with an abstract that begins "The Departments of Defense (DOD) and Veterans Affairs (VA) are establishing a medical surveillance system for the health care needs of military personnel and veterans. The system will collect and analyze information on deployments, environmental health threats, disease monitoring, medical assessments, and medical encounters. GAO has identified weaknesses in DOD's medical surveillance capability and performance during the Gulf War and Operation Joint Endeavor. Investigations into the unexplained illnesses of Gulf War veterans uncovered many deficiencies in DOD's ability to collect, maintain, and transfer accurate data on the movement of troops, potential exposures to health risks, and medical incidents during deployment. DOD has several initiatives under way to improve the reliability of deployment information and to enhance its information technology capabilities, though some initiatives are several years away from full implementation. The VA's ability to serve veterans and provide backup to DOD in times of war will be enhanced as DOD increases its medical surveillance capability."
Date: October 16, 2001
Creator: United States. General Accounting Office.
Partner: UNT Libraries Government Documents Department

Medicare: Contingency Plans to Address Potential Problems with the Transition of Dual-Eligible Beneficiaries from Medicaid to Medicare Drug Coverage

Description: Correspondence issued by the Government Accountability Office with an abstract that begins "The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) established a voluntary outpatient prescription drug benefit, known as Medicare Part D. The Centers for Medicare & Medicaid Services (CMS) is responsible for implementing this benefit. This new drug coverage will be provided through competing private Part D plans sponsored by health care organizations, which may charge premiums, deductibles, or copayments for drugs. As a result of MMA, on January 1, 2006, drug coverage for dual-eligible beneficiaries will transition from Medicaid to Medicare Part D. This transition will occur for approximately 6 million full-benefit dual-eligible beneficiaries--Medicare beneficiaries who receive full Medicaid benefits for services not covered by Medicare. CMS is in the process of implementing this transition. During May and June 2005, CMS mailed notices to these beneficiaries informing them of the transition in coverage and that they will receive a subsidy to cover their entire deductible and help cover any prescription drug plan (PDP) premiums. During October and November 2005, CMS automatically assigned dual-eligible beneficiaries to PDPs and mailed notices to these beneficiaries informing them of the assignment and also that they may select a different PDP if they wish. If they do not switch from their assigned PDP by December 31, 2005, CMS will automatically enroll them in that drug plan with coverage effective January 1, 2006. MMA provides that, after that date, dual-eligible beneficiaries may switch PDPs at any time. Dual-eligible beneficiaries are poorer and tend to have far more extensive health care needs than other Medicare beneficiaries. They are also more likely to be disabled, at least 85 years old, or to have cognitive impairments. Congress raised concerns that the single-day transition from one type of drug coverage to another could create difficulties ...
Date: December 16, 2005
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Global Malaria Control: U.S. and Multinational Investments and Implementation Challenges

Description: Correspondence issued by the Government Accountability Office with an abstract that begins "Each year, hundreds of millions of people are sickened with malaria and more than 1 million people die. Over 80 percent of all malaria deaths occur in Africa, most of them in children under the age of 5. This burden continues despite the existence of relatively simple, safe, effective, and inexpensive methods to prevent and treat malaria. The U.S. government supports the efforts of malaria-endemic countries to control malaria, both directly through agencies such as the U.S. Agency for International Development (USAID) and indirectly through its contributions to multinational organizations such as the Global Fund to Fight HIV/AIDS, Tuberculosis, and Malaria (Global Fund) and its participation in the Roll Back Malaria (RBM) Partnership. However, concerns have been raised that current global malaria control efforts may not be as effective as they could be. In light of these concerns, Congress asked us to examine U.S. involvement in global efforts to combat malaria. In this report, we (1) describe investments that have been made by the U.S. government to support the implementation of national malaria control programs in malaria-endemic countries, both directly and in partnership with other organizations; and (2) describe key challenges to the implementation of national malaria control programs and strategies for addressing those challenges."
Date: November 16, 2005
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Prescription Drugs: Improvements Needed in FDA's Oversight of Direct-to-Consumer Advertising

Description: A letter report issued by the Government Accountability Office with an abstract that begins "The Food and Drug Administration (FDA) is responsible for overseeing direct-to-consumer (DTC) advertising of prescription drugs. If FDA identifies a violation of laws or regulations in a DTC advertising material, the agency may issue a regulatory letter asking the drug company to take specific actions. GAO was asked to discuss (1) trends in drug company spending on DTC advertising and other activities; (2) what is known about the relationship between DTC advertising and drug spending and utilization; (3) the DTC advertising materials FDA reviews; (4) the number of regulatory letters that cited DTC materials and FDA's process for issuing those letters; and (5) the effectiveness of these letters at limiting the dissemination of violative DTC advertising. GAO reviewed research literature, analyzed FDA's processes, and examined FDA documentation."
Date: November 16, 2006
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Nursing Home Fire Safety: Recent Fires Highlight Weaknesses in Federal Standards and Oversight

Description: A letter report issued by the Government Accountability Office with an abstract that begins "In 2003, 31 residents died in nursing home fires in Hartford, Connecticut, and Nashville, Tennessee. Federal fire safety standards enforced by the Centers for Medicare & Medicaid Services (CMS) did not require either home to have automatic sprinklers even though they have proven very effective in reducing the number of multiple deaths from fires. GAO was asked to report on (1) the rationale for not requiring all homes to be sprinklered, (2) the adequacy of federal fire safety standards for nursing homes that lack automatic sprinklers, and (3) the effectiveness of state and federal oversight of nursing home fire safety."
Date: July 16, 2004
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Health Care Delivery: Features of Integrated Systems Support Patient Care Strategies and Access to Care, but Systems Face Challenges

Description: A letter report issued by the Government Accountability Office with an abstract that begins "Health care delivery in the United States often lacks coordination and communication across providers and settings. This fragmentation can lead to poor quality of care, medical errors, and higher costs. Providers have formed integrated delivery systems (IDS) to improve efficiency, quality, and access. The Health Care Safety Net Act of 2008 directed GAO to report on IDSs that serve underserved populations--those that are uninsured or medically underserved (i.e., facing economic, geographic, cultural, or linguistic barriers to care, including Medicaid enrollees and rural populations). In October 2009, GAO provided an oral briefing. In this follow-on report, GAO describes (1) organizational features IDSs use to support strategies to improve care; (2) approaches IDSs use to facilitate access for underserved populations; and (3) challenges IDSs encounter in providing care, including to underserved populations. GAO selected a judgmental sample of 15 private and public IDSs that are clinically integrated across primary, specialty, and acute care; they vary in their degree of integration, specific organizational features, and payer mix (e.g., extent to which they serve Medicare and Medicaid beneficiaries and the uninsured). GAO interviewed chief medical officers or other system officials at all 15 IDSs and conducted site visits at 4 IDSs, interviewing system executives and clinical staff."
Date: November 16, 2010
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Group Purchasing Organizations: Use of Contracting Processes and Strategies to Award Contracts for Medical-Surgical Products

Description: A statement of record issued by the General Accounting Office with an abstract that begins "Hospitals have increasingly relied on purchasing intermediaries--GPOs--to keep the cost of medical-surgical products in check. By pooling purchases for their hospital customers, GPOs'in awarding contracts to medical-surgical product manufacturers--may negotiate lower prices for these products. Some manufacturers contend that GPOs are slow to select products to place on contract and establish high administrative fees that make it difficult for some firms to obtain a GPO contract. The manufacturers also express concern that certain contracting strategies to obtain better prices have the potential to limit competition when practiced by GPOs with a large share of the market. GAO was asked to examine certain GPO business practices. It focused on seven large GPOs serving hospitals nationwide regarding (1) their processes to select manufacturers' products for their hospital customers and the level of administrative fees they receive from manufacturers, (2) their use of contracting strategies to obtain favorable prices from manufacturers, and (3) recent initiatives taken to respond to concerns about GPO business practices."
Date: July 16, 2003
Creator: United States. General Accounting Office.
Partner: UNT Libraries Government Documents Department

Medicare: Call Centers Need to Improve Responses to Policy-Oriented Questions from Providers

Description: A letter report issued by the Government Accountability Office with an abstract that begins "In 2002, GAO reported that the Centers for Medicare & Medicaid Services (CMS) needed to improve its communications with providers who deliver medical care to beneficiaries. GAO reported that 85 percent of the responses it received to 61 calls made to call centers operated by Medicare carriers--contractors that help manage the Medicare program--were incorrect or incomplete. GAO also found that CMS's primary oversight tools were insufficient to ensure accuracy in communication. GAO was asked whether call centers now provide correct and complete information to providers. GAO (1) reviewed carriers' effectiveness in providing correct and complete responses to policy-oriented telephone inquiries and CMS's efforts to improve communications with providers and (2) evaluated CMS's efforts to provide oversight of carrier call centers."
Date: July 16, 2004
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Disaster Preparedness: Preliminary Observations on the Evacuation of Hospitals and Nursing Homes Due to Hurricanes

Description: Correspondence issued by the Government Accountability Office with an abstract that begins "During disasters, administrators of health care facilities are faced with decisions about how to operate and care for patients, including when and how to evacuate patients if the facility becomes unable to support adequate care, treatment, or services. Hospitals and nursing homes are required to have plans in place that describe how they will operate during emergencies. Hurricanes Katrina and Rita were incidents of national significance that highlighted the challenges involved in evacuating vulnerable populations, including those in hospitals and nursing homes. Federal officials used the National Disaster Medical System (NDMS) to help evacuate patients due to Hurricane Katrina--the first time the system has been used to evacuate such a large number of patients. Formed in 1984, NDMS is a partnership among the Department of Defense (DOD), the Department of Health and Human Services (HHS), the Department of Homeland Security (DHS), and the Department of Veterans Affairs (VA). We have begun work to assess the evacuation of hospital and nursing home patients due to disasters. We are performing this work under the Comptroller General's authority to conduct evaluations on his own initiative. To conduct our review, we obtained information on (1) who is responsible for deciding to evacuate hospitals and nursing homes, (2) what issues administrators consider when deciding to evacuate hospitals and nursing homes, and (3) what federal response capabilities support the evacuation of hospitals and nursing homes. The Senate Committee on Health, Education, Labor, and Pensions requested a briefing on the preliminary observations of our review. We briefed the committee with other committees of jurisdiction on February 16, 2006. This report documents our preliminary views as presented in those briefings."
Date: February 16, 2006
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

DOD Health Care: Prohibition on Financial Incentives That May Influence Health Insurance Choices for Retirees and Their Dependents under Age 65

Description: Correspondence issued by the Government Accountability Office with an abstract that begins "From fiscal years 2001 through 2010, the Department of Defense's (DOD) spending for health care increased from about $19 billion to nearly $49 billion, representing approximately 6 percent of DOD's total spending in fiscal year 2001 and approximately 9 percent in fiscal year 2010. This health care spending primarily funds TRICARE--DOD's program that provides health care to active duty personnel and other beneficiaries, including retired servicemembers. According to DOD, the increase in its health care spending can be attributed to factors such as growth in the number of TRICARE beneficiaries. From fiscal years 2001 through 2010, the number of TRICARE beneficiaries increased by nearly 15 percent, from 8.3 million to 9.5 million beneficiaries. To help reduce DOD's health care costs, Congress passed section 707 of the John Warner National Defense Authorization Act for Fiscal Year 2007 (section 707), which went into effect January 1, 2008. Section 707 prohibits employers with 20 or more employees from offering financial or other incentives to their employees who are eligible for TRICARE to not enroll in the employer-sponsored health insurance plan or to terminate such coverage. Historically, some employers offered financial or other incentives, which resulted in shifting much of the cost of providing health care for these employees from the employer to DOD. TRICARE beneficiaries who might have been offered incentives are retirees and their dependents under age 65 who have access to employer-sponsored health insurance in addition to TRICARE. When these employees accepted the incentives and did not enroll in the employer-sponsored health insurance, TRICARE became the primary payer and paid a greater share of the health care costs. As a result of section 707's prohibition on such incentives, DOD projected, in April 2010, that there would be approximately $436 ...
Date: February 16, 2011
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Clinical Lab Quality: CMS and Survey Organization Oversight Should Be Strengthened

Description: A letter report issued by the Government Accountability Office with an abstract that begins "The Clinical Laboratory Improvement Amendments of 1988 (CLIA) strengthened and extended quality requirements for labs that perform tests to diagnose or treat disease. About 36,000 labs that perform certain complex tests must be surveyed biennially by either a state or one of six private accrediting organizations. CMS oversees implementation of CLIA requirements and the activities of survey organizations. GAO was asked to examine (1) the quality of lab testing; (2) the effectiveness of surveys, complaint investigations, and enforcement actions in detecting and addressing lab problems; and (3) the adequacy of CMS's CLIA oversight."
Date: June 16, 2006
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Improving Health Care Access for Veterans: H.R. 3230

Description: This report provides a brief comparison of the Senate ("Senate Bill") and House ("House Bill") provisions that would provide expanded authority to the VA to provide care to veterans through non-VA health care providers and facilities. This report compares only major provisions contained in Title III of the Senate version and Sections 2 and 3 of the House Version of H.R. 3230.
Date: July 16, 2014
Creator: Panangala, Sidath Viranga
Partner: UNT Libraries Government Documents Department

Overview of Health Care Changes in the FY2015 House Budget

Description: This report summarizes the proposed changes to Medicare, Medicaid, and private health insurance as described in H.Con.Res. 96 and accompanying documents, including the committee report and Chairman Ryan's Path to Prosperity report.
Date: April 16, 2014
Creator: Davis, Patricia A.; Mitchell, Alison & Fernandez, Bernadette
Partner: UNT Libraries Government Documents Department