Quantifying the resource allocation process at state health agencies

State health agencies are faced with many constraints while making resource allocation decisions - politics, finances, as well as statutory and regulatory mandates, among others. The aim of this project is to quantify the frequency and impact of common actions occurring in the resource allocation process at state health agencies, and examine differences and similarities that present across agencies and position types. As part of a national, web-based survey of state public health leaders, respondents were asked several questions regarding the resource allocation process. In total, 207 respondents (67% response rate) responded to the survey. At each state, several positions were contacted to complete the survey, including the CEO, CFO, Senior Deputy, Legislative Liaison, and the heads of Environmental Health, Preparedness, and Maternal Child Health. The data suggest that state public health leaders are highly consultative internally while making resource allocation decisions, but also frequently engage with the governor's office and the legislator - much more so at the executive level than the division/bureau level. Forty-one percent of respondents indicated they never or rarely use economic analyses or decision/prioritization tools, respectively, when making resource allocation decisions. Respondents also indicated that some activities occur with some frequency, but only affect their division or agency's budget around the margins - for instance, shifting funds from one population to another, adding activities or even eliminating activities. However, respondents said increasing and decreasing funding for certain activities both occurs frequently and has a moderate impact on the agency or division budget. Along with open-ended responses, these data suggest agencies continue to ‘thin the soup,' or prefer cutting broadly to cutting deeply. These and other findings offer quantification of important, varied practices affecting budget and priority setting that have not been well-described to-date for state health agencies.