205982 Use of epidemiologic and other population measures in funding allocation formulas for public health programs

Monday, November 9, 2009

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
Lydia L. Ogden, MA, MPP , Institute for Advanced Policy Solutions/Center for Entitlement Reform, Emory University, Atlanta, GA
David Holtgrave, PhD , Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Epidemiologists may be called to assist in designing funding allocation formulas. Major challenges include identifying available, timely, and stable data that reflect program objectives and funding needs across constituent jurisdictions. Options include measures of service needs or adjustors for differences in program costs or resource access. To identify and recommend measures representative of common funding considerations, we 1) extracted population, health, economic, and program data from multiple federal agencies; 2) developed metrics to compare alternative allocations, including measures of absolute and proportionate impacts and a cumulative distribution function (Lorenz curve); 3) considered actual or hypothetical federal public health programs that allocate funds among states, including allocations based on total population size, the number living in poverty, the prevalence of behavioral or medical risks, mortality, and historical funding precedents, with specified or de facto minimums; 4) examined correlations among various data sources and resulting allocations based on measures of poverty, income disparity, costs, and potential taxable revenues; and 5) summarized the effects of using a distilled set of need measures and cost/resource adjustors. Compared to per-capita based allocations, substituting total population size with the number of people living in poverty or the number of households receiving Food Stamps had the greatest impacts on cumulative distribution metrics, followed by adjustments for salary costs, per capita income, and various income disparity measures, such as the GINI index. As a next step, translation of analysis results will lead to guidance and tools that epidemiologists and program managers can use in considering formula design options.

Learning Objectives:
1. Describe at least 3 challenges that epidemiologists are likely to face when asked by program managers to recommend indicators and data sources for calculating funding allocation shares among constituent jurisdictions in national or state public health programs. 2. Discuss whether or not differences among areas in the cost of providing program services or the availability of local resources should be considered in funding allocations. 3. Design a funding allocation formula that advances program objectives and can be feasibly implemented.

Keywords: Financing, Funding

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the principal investigator on a project funded by the Robert Wood Johnson Foundation to evaluate alternate approaches to designing funding formulas. In this role, I lead an inter-disciplinary project team that includes expertise in the public health fields of epidemiology, program management, finance, cost-effectiveness, and policy. In addition, I have co-authored two published two peer-reviewed articles on the topic of formula-based allocations in public health practice. I have over 25 years of experience as an epidemiologist working at CDC, a state health department, and, most recently, in university-based applied research. Public health surveillance has been a focus of much of my work, and this has involved contributing to funding allocation deliberations for federal HIV/AIDS programs during the time I worked at CDC.
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.