The U.S. Department of Health and Human Services (HHS) profoundly affects the lives of all Americans. Its agencies and programs protect against domestic and global health threats, assure the safety of food and drugs, advance the science of preventing and conquering disease, provide safeguards for America's vulnerable populations, and improve health for everyone. However, the department faces serious and complex obstacles, chief among them rising health care costs and a broadening range of health challenges. Over time, additional responsibilities have been layered onto the department, and other responsibilities removed, often without corresponding shifts in positions, procedures, structures, and resources.

At the request of the U.S. House of Representatives Committee on Oversight and Government Reform, HHS in the 21st Century assesses whether HHS is "ideally organized" to meet the enduring and emerging health challenges facing our nation. The committee identifies many factors that affect the department's ability to address its range of responsibilities, including divergence in the missions and goals of the department's agencies, limited flexibility in spending, impending workforce shortages, difficulty in retaining skilled professionals, and challenges in effectively partnering with the private sector.

Contents

• THE NATIONAL ACADEMIES
• COMMITTEE ON IMPROVING THE ORGANIZATION OF THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES (HHS) TO ADVANCE THE HEALTH OF OUR POPULATION
• Independent Report Reviewers
• Foreword
• Acknowledgments
• Preface
• Summary
• 1. Introduction
  • CHARGE TO THE COMMITTEE
  • THE NATION’S HEALTH CHALLENGES
  • MEETING CHANGING NEEDS FOR 210 YEARS
  • THE HHS BUDGET
  • STRUCTURE VERSUS RESTRUCTURING
  • REFERENCES
• 2. Define a Twenty-First Century Vision
  • RECOMMENDATION 1
  • CHARTING THE DEPARTMENT’S COURSE
  • VISION, MISSION, AND GOALS AS MANAGEMENT TOOLS
  • SECURING HEALTH REFORM
  • REFERENCES
• 3. Foster Adaptability and Alignment
  • RECOMMENDATION 2
  • SCOPE OF THE CHALLENGES
  • AN IMPROVED ALIGNMENT
  • LIMIT THE NUMBER OF PEOPLE REPORTING TO THE SECRETARY
  • AN EMPOWERED SURGEON GENERAL
  • A PROTECTED CORPS OF SCIENTIFIC LEADERS
  • AN INTEGRATED PUBLIC HEALTH AGENDA
  • A STRENGTHENED SCIENCE BASE
  • STABILIZED RESEARCH FUNDING
  • A FORTIFIED STRUCTURE OF FOOD SAFETY REGULATION
  • REFERENCES
• 4. Increase Effectiveness and Efficiency of the U.S. Health Care System
  • RECOMMENDATION 3
  • HHS’S ROLE IN A VALUE-BASED SYSTEM
  • KNOWING WHAT WORKS: ESTABLISHING VALUE IN HEALTH CARE
  • EMPLOYING EVIDENCE FOR IMPROVED OUTCOMES
  • PUBLIC INFORMATION
  • FULFILL THE PROMISE OF HEALTH INFORMATION TECHNOLOGY
  • REFERENCES
• 5. Strengthen the HHS and U.S. Public Health and Health Care Workforces
  • RECOMMENDATION 4
  • SCOPE OF THE CHALLENGES
  • THE HHS WORKFORCE
  • THE U.S. HEALTH WORKFORCE
  • THE SCIENCE-BASED PROFESSIONS
  • REFERENCES
• 6. Improve Accountability and Decision Making
  • RECOMMENDATION 5
  • CURRENT DEPARTMENTAL EFFORTS
  • GREATER ACCOUNTABILITY
  • IMPROVE CAPABILITY TO MEASURE AND EVALUATE VALUE
  • GREATER DEPARTMENTAL FLEXIBILITY: A NEW COMPACT WITH CONGRESS
  • REFERENCES
• 7. The Transition
  • TRANSITION STEPS
• A Acronyms and Abbreviations
• B Letter from Congressmen Waxman and Davis
• C HHS Organizational Chart and Missions
• D U.S. Secretaries of Health, Education, and Welfare (1953–1979) and HHS (1980–Present)
• E Recommendations Directed to Congress
• F Dissenting Opinions on Recommendation 3a
• G The Reorganization Option: Views from Former Secretaries of the U.S. Department of Health and Human Services
• H Statutory Framework for the Organization and Management of the U.S. Department of Health and Human Services
• I Committee and Staff Biographies

Suggested citation:

IOM (Institute of Medicine). 2009. HHS in the 21st century: Charting a new course for a healthier America. Washington, DC: The National Academies Press.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

Support for this project was provided by the National Academies. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the organizations or agencies that provided support for the project.