Who gets how much: funding formulas in federal public health programs

Federal public health programs use a mix of formula-based and competitive methods to allocate funds among states and other constituent jurisdictions. Characteristics of formula-based allocations used by a convenience sample of four programs, three from the Centers for Disease Control and Prevention and one from the Health Resources and Services Administration, are described to illustrate formula-based allocation methods in public health. Data sources in these public health formulas include population counts and funding proportions based on historical precedent. None include factors that adjust allocations based on variations in the availability of local resources or the cost of delivering services. Formula-funded activities are supplemented by programs that target specific prevention needs or encourage development of innovative methods to address emerging problems, using set-aside funds. A public health finance research agenda should address ways to improve the fit between funding allocation formulas and program objectives.