April 2000 Bulletin

Clinton budget expands research

Earmarks 5.6% increase for NIH; 3.3% for NIAMS

President Clinton’s proposed $1.84 trillion budget for fiscal year 2001 includes a major expansion of health care and signals the start of a political struggle between Republicans and Democrats to shape the nation’s priorities. Here are some of the president’s budget proposals for medical research.

Clinton’s budget for the fiscal year starting October 1 requests $427.4 billion for the Department of Health and Human Services (HHS). That’s an increase of $27.1 billion, or 6.7 percent, more than current spending. The discretionary portion of the HHS budget totals $48.6.billion, an increase of 15.4 percent from fiscal year 2000.

The budget calls for a 5.6 percent increase for National Institutes of Health (NIH), bringing the agency’s total budget to $18.8 billion. Approximately 82 percent of the funds are for extramural research. Ten percent of the budget supports a core program of basic and clinical research activities administered and staffed by NIH physician and scientists, and the remaining 8 percent provide research management and support, agency administration, and intramural facilities. NIH is continuing to focus on four programmatic themes: exploit genomics, invigorate clinical research, harness the expertise of allied disciplines and reduce health disparities at home and abroad.

The support of basic medical research through competitive, peer-reviewed, and investigator-initiated research project grants (RPGs) continues to be one of NIH’s highest funding priorities. These grants support new and experienced investigators in broad-based research programs. In fiscal year 2001, the NIH budget proposal provides $10.3 billion, or 6.1 percent more than in fiscal year 2000, to fund an estimated 31,524 projects, the highest total level ever. This represents additional 237 total grants over fiscal year 2000. It is estimated that this would support 7,641 competing RPGs in fiscal year 2001. This number is 1,309 below estimated fiscal year 2000 levels, largely as a result of the record high number of continuation grants.

To ensure that NIH can maintain a sufficient number of new awards, especially for first-time investigators, it is proposed that noncompeting RPGs would be limited to increases of 2 percent on average for recurring costs and competing RPGs would receive average cost increases of 2 percent over fiscal year 2000. With this, the average cost of a new and competing RPG award would rise to about $321,500, a 26 percent increase over fiscal year 1998.

The proposed budget for National Institute for Arthritis and Musculoskeletal and Skin Diseases (NIAMS) is $363.479 million, a 3.3 percent increase from the fiscal year 2000 budget of $351.840 million. The NIAMS Coalition is urging that Congress significantly increase to $404.616 million, a 15 percent increase.

The budget request for Agency for Health Care Research and Quality (AHRQ) supports a total program level of $250 million, an increase of $44 million, or 21.3 percent, more than current funding. In actuality, the total budget authority for this agency is zero; all funds are derived from transfers from other public health programs, including NIH.

In fiscal year 2001, AHRQ would dedicate $20 million to conduct research directed toward reduction in medical errors. The budget summary noted that the nation’s efforts to reduce workplace injuries have been very successful over the years, but more work is needed, and AHRQ would direct $10 million in research to improve employee health services. Research would focus on improving the quality of health care delivery systems through which employees receive health care services; the quality of the health care workplace and its impact on the quality and outcomes of care; and the outcomes and effectiveness of clinical services employees receive.

It is proposed that AHRQ would dedicate $10 million toward the development of health information technology applications. The Administration believes that the use of information systems and computerized decision support systems has the potential to improve the quality and efficiency of care.

The Centers for Disease Control and Prevention (CDC) budget request totals $3.5 billion, an increase of $201 million or 6 percent more than current funding. Among the priorities, the budget includes $202 million to fight infectious diseases, an increase of $26 million, a 15 percent from fiscal year 2000. Within infectious diseases, $123 million would be allocated for emerging infectious diseases and $5 million for Hepatitis C. The budget notes that emerging infectious diseases contribute substantially to the burden of disease borne by the American public. About two-thirds of the CDC budget includes such initiatives as $795 million for HIV/AIDS.

The CDC budget includes $220 million for National Institute for Occupational Safety and Health (NIOSH), an increase of $5 million from fiscal year 2000 to continue research in areas such as musculoskeletal injuries and traumatic injuries. The budget includes $87 million, an increase of $5 million for CDC to support the initiative to combat Violence Against Women.

President’s budget requests

Health, Human Services

$427.4 billion

NIH

18.8 billion

NIAMS

363.4 million

AHRQ

250 million

CDC

3.5 billion


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