The U.S. Department of Health and Human Services (HHS)—which boasts the largest budget of any federal department, spending approximately 2 billion dollars a day—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, the IOM’s December 2008 report 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.

In order to meet the nation’s twenty-first century health care challenges, the committee believes the nation needs and deserves a department exceptional at performing its core function—protecting the health of all Americans. To achieve that goal, the Department of Health and Human Services must be revitalized. It must work more collaboratively with Congress, the rest of the federal government, and other health stakeholders to provide value both within the department and throughout the health care system. 

The committee emphasizes the need for improved departmental performance and processes for goal setting, decision making, and management, and accountability rather than a large-scale reorganization of the entire department, for a variety of reasons. The committee identifies five areas of action to improve the performance of the department:

• Defining a twenty-first century vision
• Fostering adaptability and alignment
• Ensuring effectiveness and efficiency of the U.S. health care system
• Stengthening the HHS and U.S. public health and health care workforces
• Improving accountability and decision making