Reference allocations and use of a disparity measure to inform the design of allocation funding formulas in public health programs.
Funding formulas are commonly used by federal agencies to allocate program funds to states. As one approach to evaluating differences in allocations resulting from alternative formula calculations, we propose the use of a measure derived from the Gini index to summarize differences in allocations relative to 2 referent allocations: one based on equal per-capita funding across states and another based on equal funding per person living in poverty, which we define as the "proportionality of allocation" (PA). These referents reflect underlying values that often shape formula-based allocations for public health programs. The size of state populations serves as a general proxy for the amount of funding needed to support programs across states. While the size of state populations living in poverty is correlated with overall population size, allocations based on states' shares of the national population living in poverty reflect variations in funding need shaped by the association between poverty and multiple adverse health outcomes. The PA measure is a summary of the degree of dispersion in state-specific allocations relative to the referent allocations and provides a quick assessment of the impact of selecting alternative funding formula designs. We illustrate the PA values by adjusting a sample allocation, using various measures of the salary costs and in-state wealth, which might modulate states' needs for federal funding.
Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA. jwb2@cdc.gov
James W
JW
Buehler
Patrick M
PM
Bernet
Lydia L
LL
Ogden
D000206:Actuarial Analysis; D017047:Cost Sharing / Q000706:statistics & numerical data; D003365:Costs and Cost Analysis; D005381:Financing, Organized / Q000379:methods*; D006302:Health Services Research; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D015233:Models, Statistical; D011159:Population Surveillance; D011203:Poverty / Q000706:statistics & numerical data*; D016730:Program Development / Q000191:economics*; D015397:Program Evaluation; D015980:Public Health Practice; D040841:Resource Allocation / Q000706:statistics & numerical data*; D014481:United States