The purpose of this study was to gain an empirical understanding of the types of allocation decisions local health officials (LHOs) make and the factors that influence those allocation decisions.
We conducted a national survey of LHOs in the United States in 2008 to 2009. The sample was stratified by the size of the population served by the department. We merged our data with data from the 2008 National Association of County and City Health Officials Profile survey. Descriptive statistics were generated using weighted data.
Our final sample size was 608 respondents, with an average of 10 years experience. The LHOs reported little shifting of resources among population groups but greater capacity to redirect staffing time. Less than half of LHOs reported using economic analyses or conducting needs assessments when setting priorities. Having sole provider status in a community strongly influenced LHOs' allocation decisions. In addition, the effectiveness of activities, previous budget allocations, and input from boards of health were influential factors in allocation decisions. Public expectations were moderately to very influential, but direct public input had a low impact on allocation decisions.
Survey findings provide a clearer understanding of how LHOs fulfill their obligations as stewards of public health resources and ensure effective activities and access to needed services. It may be useful to assess the value of more structured allocation methods (eg, decision frameworks) in the allocation process. Expanding opportunities for public engagement in priority setting may also be valuable for difficult allocation decisions.
This study aimed to gain an empirical understanding of the types of allocation decisions local health officials make and the factors that influence those allocation decisions.
Department of Health Management and Policy, University of Michigan School of Public Health (Drs Baum and Goold) and University of Michigan Center for Bioethics and Social Sciences in Medicine and Department of Internal Medicine (Dr Goold), Ann Arbor; and Harvard Medical School and Massachusetts General Hospital, Boston (Drs DesRoches and Campbell).
Correspondence: Nancy M. Baum, PhD, MHS, Department of Health Management and Policy, University of Michigan School of Public Health, 1415 Washington Heights, M-3141 SPH-II Ann Arbor, MI 48109 (email@example.com).
This research was supported by a grant from the Changes in Health Care Financing and Organization-–a national program of the Robert Wood Johnson Foundation.
The authors thank the National Association of County and City Health Officials for guidance during study development and for access to data from the 2008 National Profile of Local Health Departments Survey, 2008, and the funders of the profile survey: the Centers for Disease Control and Prevention, and the Robert Wood Johnson Foundation. They also thank the 4 thoughtful reviewers.