7. 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 CMS reimbursement policy.

Scientific research projects typically extend well beyond a single fiscal year. Predictability in funding is important, and delays in budget approvals can be especially injurious to the large, multiyear, multi-institutional, multidisciplinary projects that now distinguish scientific inquiry (IOM, 2003), from which so much has been learned about disease risk factors and treatments (NHLBI, 2007).

HHS’s use of, and support for, science can be impeded by uncertainties about the department’s annual budget, especially during extended congressional consideration. For example, the 2009 HHS budget appears unlikely to be adopted until February 2009, with the government operating under a continuing resolution bill enacted in September 2008. Under previous continuing resolutions, NIH has given investigators with ongoing projects 80 percent of their approved budgets for the continuing resolution period, typically a few months. Unfortunately, when a budget is delayed until over a third of the fiscal year has elapsed, this can have a significant impact on research funding. Because of the below-inflation percentage increase in the 2009 proposed President’s budget for NIH, if the agency is funded at that level, it may be forced to award fewer grants in fiscal year 2010 (Bhattacharjee et al., 2008).

Budget delays—and any perception that HHS is a less-than-hospitable environment for scientists—compound difficulties in recruiting and retaining the quality and quantity of scientists needed to support agency missions—whether in the biomedical sciences, social sciences, biostatistics and epidemiology, or health services research.

Budgets of HHS science agencies have fluctuated greatly in recent years. NIH and CDC experienced large increases after 2000 (see Figure 1-3 in Chapter 1) and then saw little growth or experienced actual reduc-