204557 Public health funding formulas in political context

Tuesday, November 10, 2009: 2:50 PM

Lydia L. Ogden, MA, MPP , Institute for Advanced Policy Solutions/Center for Entitlement Reform, Emory University, Atlanta, GA
James W. Buehler, MD , Rollins School of Public Health, Epidemiology Dept., Emory University, Atlanta, GA
Patrick Bernet, PhD , Assistant Professor of Healthcare Management, Florida Atlantic University, Boca Raton, FL
Public health funding formula developers must understand how different designs shape allocations and how recommendations for designing formulas—including the development process itself—will be received in a political context.

Any funding formula leads to multiple policy questions, but three of the most fundamental are: Should formulas seek to promote funding equity or service equivalency? What are the potential unintended consequences of different funding allocation strategies? How could these be mitigated? Our research considers financial impacts of alternative measures for allocating funds to states in selected federal public health programs. The objective of policy analysis is to interpret these findings in light of the broader political context in which they will be received. Choices concerning funding formulas – e.g., financing (sources of revenue and the implications for equity of those sources), structure (block grants, categorical funding, matching rates, etc.), and definitions of need – profoundly affect perceptions of program efficiency, effectiveness, impact, and utility.

In any situation where allocation of public funds is at stake, a mix of political forces predictably comes into play as advocates for particular jurisdictions or programs seek to protect or increase funding. The role of self-interest, especially when accompanied by political power, may be a barrier to optimal formula design. Political leaders and community representatives may have unrealistic expectations regarding the number and precision of factors that should be incorporated formulas. The concept of pay for performance increasingly shapes debates about public health spending, which argues for consideration of performance measures in formulas and spending allocations.

Learning Objectives:
1. Describe the application of funding formulas in public health. 2. Analyze the strengths and limitations of funding formulas in policy development, program prioritization, and public health funding decisions at three levels: federal, state, and local jurisdictions. 3. Describe a process for implementing formula-based funding decision-making in varied public health jurisdictions.

Keywords: Fiscal Policy, Public Health Policy

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am one of a team of four individuals funded by RWJF for this project. The PI and other team members have reviewed this abstract and concur with its content and submission.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.