This article reports findings from an assessment by the Office of Technology Assessment (OTA), an analytical arm of the U.S. Congress. In brief, OTA found the conventional wisdom that American adolescents as a group are so healthy that they do not require health and related services is not justified. Even more disturbing, U.S. adolescents often face formidable barriers in trying to obtain health care. OTA suggested that Congress could act to 1) increase adolescents' access to health care, most effectively by supporting school- or community-based comprehensive health services specifically for adolescents, 2) restructure and reinvigorate the federal role in adolescent health, most visibly by creating an office of adolescent health in the U.S. Executive branch, and 3) improve adolescents' social environments, by providing more support to the families of adolescents, limiting adolescents' access to firearms, supporting the expansion of recreational opportunities for adolescents, and further supporting opportunities for community service. Congressional actions taken since the release of OTA's report are summarized.

A National Academy of Sciences study of policy options for the supply of primary health-care manpower has produced a comprehensive set of recommendations. The study finds an adequate overall supply of physicians, but a shortage of primary health-care practitioners. It recommends maintaining current enrollment levels in medical schools and training programs for nurse practitioners and physician assistants and increasing the proportion of primary-care residents. To enhance the availability of primary care, the report advocates reimbursement for all physicians within a state at the same payment level for the same primary-care service, a reduction in payment differentials between primary-care services and nonprimary-care services, and reimbursement for educational and preventive services and for new health-practitioner services. The report supports a team approach in primary-care training and recommends that all medical students obtain clinical experience in a primary-care setting and some instruction in epidemiology and behavioral and social sciences.

One possible approach to containing Medicare costs involves explicit changes in Medicare's coverage policy with respect to medical technology. This paper first describes the development and diffusion of medical technology in general and then describes how technologies are identified, assessed, and approved for payment by Medicare. Currently, cost is neither a criterion nor an explicit issue in coverage decisions, although coverage policy is an integral part of payment policy. A combination of policies to reduce the rates of adoption and use of certain technologies is needed--including cost considerations in technology assessments for coverage decisions, limiting diffusion of technology to certain providers and sites, limiting utilization to certain indications, and tightening administrative processes. Finally, the interaction between coverage policy and DRG payment needs to be explored more thoroughly.

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