HHS in the 21st Century Charting a New Course for a Healthier America (2009) / Chapter Skim
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1 Introduction
1 Introduction
Pages 21-38
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From page 21... ...
. 1 Medicare is a federally administered entitlement program funded through payroll taxes that are set aside for that specific purpose and outside of the department's control; the Medicaid program is a federal-state partnership program for some categories of lowincome Americans (with the largest share of payments going to the elderly and disabled individuals needing long-term care)
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From page 22... ...
HHS touches the lives of virtually every American. Its agencies help pay for medical care for elderly, disabled, and low-income Americans; they protect our population against domestic and global health threats; they ensure the safety of our food and medications -- regulating more than $1 trillion of the U.S.
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From page 23... ...
These programs support a variety of services including community-based programs for older persons, Temporary Assistance for Needy Families, Head Start, adoption and foster care services, and prevention of family violence. As is discussed in Chapter 3, an individual's health is determined by a variety of complex factors, including socioeconomic status, and the Administration on Aging and the Administration for Children and Families play an important role in assuring not only the financial well-being of their constituents, but also their health.
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From page 24... ...
, Representatives Henry A Waxman and Tom Davis, chair and ranking minority member, respectively, of the House Committee on Oversight and Government Reform posed the question of whether HHS is "ideally organized" to meet the public health and health care cost challenges that require a focused national response (see Appendix B)
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From page 25... ...
We see an aging population and climbing rates of costly chronic diseases, evolving risks of infectious diseases, the need for stronger emergency preparedness, weaknesses in the public health infrastructure, health risks from climate change, new outbreaks of food-borne diseases, and serious shortages of many key health professionals -- all in the context of rising national health care costs, which limits the degrees of freedom to make system changes. Yet system changes are needed, in order to ensure that all Americans have access to basic health care and that the care we do receive is of high quality.
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From page 26... ...
-- the science and practice dealing with the pre vention of disease and injury and the protection and improvement of the health, safety, and well-being of groups of people, as contrasted with the individual care a person receives from a doctor, nurse, or other health care practitioner. Public health programs operate at the national, state, and local levels to, for example: • Provide immunizations, • Prevent tobacco use, • Train communities in emergency preparedness, • Better manage the costly consequences of chronic diseases, • Ensure food safety, • Track disease patterns, • Prevent and control transmission of infectious diseases, • Operate health programs for pregnant women and infants, and • Research new disease prevention and treatment methods.
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From page 27... ...
THE HHS BUDGET Today, the department has 11 operating divisions, has 15 staff divisions, and implements more than 300 programs (HHS, 2008)
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From page 28... ...
NOTES: ACF = Administration for Children and Families; AHRQ = Agency for Healthcare Research and Quality; AoA = Administration on Aging; CDC = Centers for Disease Control and Prevention; CMS = Centers for Medicare and Medicaid Services; FDA = Food and Drug Administration; HRSA = Health Resources and Services Administration; IHS = Indian Health Service; OCR = Office for Civil Rights; OIG = Office of the Inspector General; OMHA = Office of Medicare Hearings and Appeals; ONCHIT = Office of the National Coordinator for Health Information Technology; PHSSEF = Public Health and Social Services Emergency Fund; SAMHSA = Substance Abuse and Mental Health Services Administration; SCHIP = State Children's Health Program, a component of Medicaid.
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From page 29... ...
. As demonstrated in Figure 1-2, HHS's budget is dominated by the Centers for Medicare and Medicaid Services, whose spending 3 grew from almost $350 billion in FY 2001 to $570 billion in FY 2007, with the President's budget request for FY 2009 standing at $635 billion -- 3 The CMS spending figures for 2001 and 2007 include discretionary spending as well as the mandatory outlays for Medicare and Medicaid/State Children's Health Insurance Program (SCHIP)
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From page 30... ...
. Medicaid/SCHIP 29.32% Other Mandatory 5.07% NIH 4.31% Other Discretionary 5.99% Mandatory Medicare 55.30% Discretionary FIGURE 1-4 HHS mandatory and discretionary budget allocations, 2007.
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From page 31... ...
. Interviews performed for the IOM committee with six former secretaries, who began their tenures at the beginning of the past six Presidencies, revealed varying views on the usefulness of a major departmental reorganization.
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As noted, HHS is a large, complex enterprise with many constituencies, each of which wishes that the department's activities and performance would meet its particular needs; collectively, these external forces create the complex environment that the secretary must skillfully navigate. Organizational management literature is replete with advice and tools related to improving efficiency and effectiveness.
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From page 33... ...
The committee believes that the department will derive great benefit from comprehensive organizational reform strategies that take into account fundamental structures and processes, such as those listed above. While significant alterations in HHS structure would not be easy -- or even possible -- the decision-making and management processes at all levels of the department can change, and this is where the new secretary can make the most progress in responding to the concerns the House committee has raised.
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From page 34... ...
d. The secretary should work with the President and Congress to establish a selection process for the department's senior-level officials that pro tects the scientific and administrative integrity of major departmental units, promotes progress toward departmental goals, and is based pri marily on the candidates' qualifications and experience.
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From page 35... ...
f. The secretary should ensure that all department health programs, in cluding the reimbursement programs, reinforce public health priorities and strategies in order to provide a consistent framework for protecting the public from health risks, promoting health, preventing disease and disability, and providing health services for vulnerable populations in the most efficient, cost-effective ways.
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From page 36... ...
f. Congress should give the secretary authority to create new programs that invest in the future generation of biomedical and health services re searchers, enabling the continued discovery of new, more effective methods of preventing, treating, and curing disease; promoting health; improving health care delivery and organization; and controlling health system costs.
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From page 37... ...
c. The department should use the data, evaluation, and information system to -- enable the secretary to provide Congress with regular reports on progress toward achieving departmental goals, -- inform policy development, -- facilitate cross-department activities, -- provide operational information to program management for quality improvement and midcourse corrections, and -- support effective long-range planning.
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From page 38... ...
2008b. Budget of the United States government: Federal employment and compensation tables fiscal year 2009: Federal civilian employment in the ex ecutive branch (table 24-1)
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Key Terms
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