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Am Fam Physician. 1998;58(3):635-636

Coalition of Health Professionals Fighting Anti-Affirmative Action Initiative

The Health Professionals for Diversity Coalition, which is made up of 51 national health and education-related organizations, including the Association of American Medical Colleges and the American Academy of Family Physicians, is mounting a campaign against an anti-affirmative action proposition in the state of Washington. Initiative 200 will appear on the November 3 ballot. If it passes, state and local governments would not be allowed to use affirmative action programs to ensure equal opportunity for qualified women and minorities in public employment, education and contracting. Members of the Health Professionals for Diversity Coalition support a set of principles that states, “affirmative action, including the right to consider race/ethnicity among the many factors that may be reviewed in admission decisions, is still needed to produce a diverse health professions work force.”

Institute of Medicine Expresses Concerns About New Medicare+Choice Marketing Plan

An Institute of Medicine (IOM) Committee on Choice and Managed Care, co-chaired by Harry P. Cain II, Ph.D., and Stanley B. Jones, has issued a letter report to the administrator of the Health Care Financing Administration (HCFA) expressing concerns about HCFA implementation of the Medicare+Choice option established in the Balanced Budget Act of 1997. Medicare+Choice will give many elderly persons more health plan options. HCFA plans a mailing to all 39 million Medicare beneficiaries in November announcing the new program. However, the IOM committee cautions that “despite HCFA's best efforts, a fall health plan marketing campaign is likely to produce, at the very least, a high level of confusion and anxiety among Medicare recipients—perhaps a backlash—and a host of questions about the impending changes.” The committee has provided HCFA a set of recommendations to minimize the potential confusion among beneficiaries. The full text of the letter is on the IOM Web site at

New Initiative to Improve the Quality of Care in Nursing Homes

In August, the Clinton Administration announced a new initiative to provide enhanced protections for residents of nursing homes and to target specific needed improvement in nursing home care. According to Health and Human Services Director Donna E. Shalala, an independent report to Congress shows progress since strong nursing home enforcement regulations took effect in 1995, but additional steps will now be taken to address remaining problem areas, including those identified in the report. The new initiative includes tougher enforcement of Medicare and Medicaid rules with strengthened oversight of nursing home quality and safety. Particular efforts will be aimed at preventing instances of bed sores, dehydration and nutrition problems. A few of the administration's new approaches to improve nursing home care follow: nursing homes found guilty of a second offense for violations that harm residents will face immediate sanctions; federal and state officials will focus their enforcement efforts on nursing home chains that have a record of noncompliance with federal rules; inspections will be done more often for repeat offenders with serious violations, but inspections at other facilities will not be decreased; and individual nursing home survey results and violation records will be posted on the Internet to increase accountability and make information more accessible.

Study Reveals Staggering Costs of Alcohol and Drug Abuse in the United States

A study released by the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) revealed that the economic cost of alcohol and drug abuse in the United States in 1992 (the most recent year for which data were available) was $246 billion. “This study confirms the enormous damage done to society by alcohol- and drug-related problems,” said NIAAA Director Enoch Gordis, M.D. “The magnitude of these costs underscores the need to find better ways to prevent and treat these disorders.” Most of the costs of alcohol abuse, according to the report, were related to lost productivity, either from alcohol-related illness (45.7 percent) or premature death (21.2 percent). Other costs related to treatment (12.7 percent), motor vehicle crashes (9.2 percent) and crime (8.6 percent). For drug abuse, more than one half of the estimated costs were associated with crime. Most of the remaining costs of drug abuse resulted from premature deaths (14.9 percent), lost productivity from illness (14.5 percent) and health care expenditures (10.2 percent). The 1995 costs to society were projected to be $275 billion.

AHCPR Will Launch a National Guideline Clearinghouse on the Internet

The Agency For Health Care Policy and Research (AHCPR), in partnership with the American Association of Health Plans and the American Medical Association, is sponsoring the development of the National Guideline Clearinghouse (NGC), which will be a comprehensive electronic repository for clinical practice guidelines and related materials. The AHCPR is inviting health care organizations and other public and private sector entities to submit clinical practice guidelines for inclusion in the NGC, which will have its own Web site on the Internet ( beginning this fall. To be included in the NGC, guidelines must meet specified inclusion criteria. The following elements will be available with the full text of each guideline: a standardized abstract with information about the guidelines; a comparison of guidelines that cover similar topic areas; and topic-related electronic mail groups in which registered users may exchange information about the guidelines. More information about the NGC can be obtained on the Web site of the AHCPR at or by contacting AHCPR Public Affairs at 301-594-1364.

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Copyright © 1998 by the American Academy of Family Physicians.

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