cutbacks from Medicaid educational opportunities or from clinical funds that formerly supported research faculty salaries remains to be determined.*

In addition, some of the discussions focused on the fact that research on emerging and reemerging infections is threatened by the decline of microbiology laboratories in academic health centers. For example, CDC has noted a decline in the quality of testing that has been performed on the samples that it receives, and this decline in quality may weaken the public health system's ability to recognize an emerging pathogen or disease outbreak. A possible solution that was discussed at the workshop and that may combat the decline would be the creation of centers of excellence in microbiology with links to the large populations in stable, research-oriented HMOs. Consequently, there is an immediate need to gauge the health of the nation's public health laboratories, a topic that will be addressed in an upcoming workshop of the Institute of Medicine Forum on Emerging Infections.


 After this workshop was held, a new report from the Institute of Medicine examined both the evidence for extending coverage for routine care during clinical trials and the cost to Medicare of doing so. The report, Extending Medicare Reimbursement in Clinical Trials (IOM, 1999), recommends that Medicare should pay for routine care of beneficiaries enrolled in clinical trials in the same way it pays for this care outside of clinical trials. The report urges HCFA to issue unambiguous rules to end widespread uncertainties about what should or should not be reimbursed. The authoring committee noted that since Medicare has a stake in ensuring that the medical interventions it pays for are effective, it would be sound policy to remove any disincentives to the participation of Medicare recipients in clinical trials. However, Medicare should not pay for unapproved drugs and devices, or radical new procedures, unless reimbursement is already allowed under a prior agreement with the federal government. All data-collection costs should remain the responsibility of the researchers or their sponsors.—Ed.

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