Related Recommendation

  1. The secretary should establish a vision, mission, and goals that respond to twenty-first century challenges, enable greater programmatic continuity over time, and that can be used to focus department staff and activities on leading priorities, strengthen the public health infrastructure, facilitate assessment of impact, and lead to corrective action.


A major theme of this report is about building value into the work of HHS, and it is equally vital to build greater value into our nation’s health system. HHS is deeply affected by current problems in the system and can be a major force in their solution. High health care costs, lack of access to care, poor quality and outcomes—a Venn diagram of overlapping influences—are the major sources of mounting pressure for health reform—among the public, health professionals and providers, and policy makers.

When Congress requested this report, it asked that the Institute of Medicine (IOM) consider the department’s preparedness to meet the nation’s greatest health care challenges: advancing health and controlling health care costs. The consensus of many experts—and the IOM committee—is that these challenges cannot be met without comprehensive health reform.

Comprehensive reform would result in a health system that produces more value for Americans. It would be characterized by improved access to care and coverage; it would promote higher quality care, including all the attributes identified by the IOM (safe, effective, patient centered, timely, efficient, equitable) (IOM, 2001), and it would emphasize health promotion and prevention of disease and disability. Efforts at health reform should take this comprehensive approach, the committee believes, so that a reformed system is sustainable and accountable, has the necessary and appropriate workforce, and again, creates value in response to the massive investments of the American people.

As far back as the 1930s, attempts have been made to rationalize the U.S. health care system by proposing changes in the way the nation pays for health care (Committee on the Costs of Medical Care, 1932), but powerful interest groups and opponents of federal and state government

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