244993 States' use of formulas for public health funding allocations: Policy, practice, and political aspects

Tuesday, November 1, 2011: 5:10 PM

Lydia Ogden, PhD, MPP , Office of Prevention Through Healthcare, Centers for Disease Control and Prevention, Atlanta, GA
Katie Sellers, DrPH, CPH , Research and Evaluation, Association of State and Territorial Health Officials, Arlington, VA
Cara Sammartino, MSPH , Department of Health Policy and Management, Emory University, Atlanta, GA
James W. Buehler, MD , Rollins School of Public Health, Epidemiology Dept., Emory University, Atlanta, GA
Patrick Bernet, PhD , Associate Professor of Healthcare Management, Florida Atlantic University, Boca Raton, FL
Public health funding formulas have received less scrutiny than those used in other government sectors, particularly health services (e.g., Ryan White AIDS programs) and public health insurance (e.g., Medicaid). Little is known about states' strategies to allocate public health funds. We conducted a mixed methods survey with state chief financial officers to determine their use of funding formulas for public health distributions. We sought information on state health agencies' use of funding formulas for specific public health activities; sources of funding; formula attributes (inputs, adjustors); formula development (e.g., whether a formula was mandated in statute or regulation, developed by the health department, the role of stakeholders); and assessments of political and policy considerations related to formula-based allocations. Results show that states' use of funding formulas is correlated with the number of local health departments and with the percentage of public health funding provided by the federal government. States use a variety of allocative strategies, but most commonly employ a “base-plus” distribution. State health departments have varying experiences and degrees of sophistication in their use of funding formulas. Metrics for risk, need, burden of disease, and performance may not be current, readily available, or robust. The effects of varied metrics and adjustors in formulas is not well understood. Formula development and use is seen as politicized, with questions arising regarding allocations' fairness. Information for decision-making is central to good public health practice, including the development of formulas for funding allocations. Federal public health should work with state and local partners to achieve this end. States' experiences and best practices should be disseminated, along with policy guidance on formula development.

Learning Areas:
Administration, management, leadership
Program planning
Public health administration or related administration
Public health or related public policy

Learning Objectives:
1. Discuss the fiscal and political context of formulas for public health funding allocations. 2. Analyze differences between federal and state funding formula allocations. 3. Identify structural and administrative characteristics of state health departments that use funding formulas.

Keywords: Funding, Policy/Policy Development

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I was the primary researcher on this survey. I have worked for more than 20 years in public health program administration 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.

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