ity, and providing health services for vulnerable populations in the most efficient, cost-effective ways.

  1. To maximize value in the health care system, the secretary must strengthen the scientific base and capabilities of the department and ensure that agencies’ research findings are shared department-wide and that current best evidence is used for departmental decision making, including the Centers for Medicare and Medicaid Services (CMS) reimbursement policy.

  2. Congress should allocate sufficient, predictable funding for NIH, CDC, FDA, and AHRQ in order to preserve and enhance these agencies’ scientific missions. Congress should also establish a specific budget line for AHRQ that is independent of appropriations to other HHS agencies.

  3. To address the growing threat of food-borne illnesses, Congress should unify the USDA’s Food Safety and Inspection Service and the food safety activities of FDA within HHS and ensure provision of adequate resources for high-quality inspection, enforcement, and research.


Health care accounts for nearly one-sixth of the U.S. gross domestic product, and Medicare and Medicaid account for 85 percent of HHS expenditures. These programs significantly contribute to rising national debt, and continued escalating costs threaten their sustainability.

Worse, our high national health care expenditures have not produced commensurate gains in the health of the nation or in the quality of care Americans receive. Research comparing the marked differences in care patterns (frequency of surgery, for example) provided in different parts of the country shows that not only are some patterns much more expensive, but residents of these high-cost areas have no better—and sometimes worse—health outcomes.

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