Budget and priority setting in a time of scarcity

Background: Questions of resource allocation – who gets what, and why – have been present in public debate around medical spending for decades. Some of these issues in scarce resource allocation, beyond questions of finance and funding, were crystallized with the brief but frightening onset of SARS and Anthrax attacks earlier this decade, as well as the potential of an avian influenza pandemic. Who would get the scarce vaccine or antiviral became extremely important to preparedness professionals and the public alike. But questions of the allocation of public health funds for different types of programs are present in everyday budget-setting, as well. As such, an inquiry into the budget-setting process in state health agencies was undertaken. Methods: Qualitative, in-depth interviews were conducted with public health officials from 6 state public health agencies by telephone. Purposive sampling was utilized to recruit state health officers, deputy directors, department budget officers, legislative liaisons, Preparedness division heads, Environmental Health Sciences division heads, and Maternal/Child health division heads from these states states. These six states were identified based on geographic location, spending characteristics and other agency characteristics (e.g., relation to local health departments). Approximately 7-8 interviews were conducted at each participating state. Presentation of findings: This presentation will describe the budget- and priority-setting process as identified by state health agency employees. The author will discuss what issues and factors are critical to decision makers, whether these are shared across divisions, states, and individuals, as well as how various pressures (political, economic, ethical) affect the process. Additionally, the presentation will explore how different funding sources and formulae, e.g., differing amounts from state funding pools, private industry or foundations, or varying amounts of federal monies, affect decision-making.