Decision Science

A Scientific Approach to Enhance Public Health Budgeting

A decision analysis software program helped the Spokane Regional Health District in Spokane County, Washington create a budget that was more transparent, revealing how and why decisions were made.

Public health organizations usually create budgets through an informal process; agencies generally grant funding to programs that appear needy. The administrators in charge of creating budgets rely on information from competing program directors; budgets do not necessarily reflect the best interest of the entire agency. Decision analysis transforms budgeting into a scientific process; it breaks a problem into discrete parts that an organization can analyze.

This article explains the key features of decision analysis and describes how the Spokane Regional Health District implemented a decision analysis software program. The Spokane Regional Health District governs almost 50 public health programs. The district created a decision-making framework, or a hierarchy chart, from numerous goals and sub-goals. The health district’s management team initially created a broad set of budget goals. They met weekly for six months to decide what goals they would enter into the software program.

Key Findings:

  • Spokane Regional Health District eliminated funding to four programs.
  • Based on data generated by the decision analysis software, the Spokane Regional Health District conducted a review of 15 of its programs.
  • The health district discontinued its clinical services program, transferring the activities to community-based Federally Qualified Health Centers.

A public health agency must distribute its limited resources among competing programs. A budget usually has a limited role within a public health organization. This article describes how decision analysis helped the Spokane Regional Health District take a more scientific approach to budgeting.

April Issue of Health Affairs Focuses on Patient Safety and Health Care Quality

  1. 1 The Ongoing Quality Improvement Journey
  2. 2 A Road Map for Improving the Performance of Performance Measures
  3. 3 The Trade-Off Among Quality, Quantity, and Cost
  4. 4 Global Trigger Tool' Shows that Adverse Events in Hospitals May be Ten Times Greater Than Previously Measured
  5. 5 Preventing Bloodstream Infections
  6. 6 Measuring the Performance of Individual Physicians by Collecting Data from Multiple Health Plans
  7. 7 Measuring Health Care Performance Now, Not Tomorrow
  8. 8 Despite Improved Quality of Care in the Veterans Affairs Health System, Racial Disparity Persists for Important Clinical Outcomes
  9. 9 The Importance of Transitional Care in Achieving Health Reform
  10. 10 An Early Status Report on the Beacon Communities' Plans for Transformation Via Health Information Technology
  11. 11 A Comparative Study of 11 Local Health Department Organizational Networks
  12. 12 Public Health Performance
  13. 13 A Self-Assessment Process for Accreditation Preparedness
  14. 14 Public Health Delivery Systems
  15. 15 Regionalization in Local Public Health Systems
  16. 16 Public Health Services and Systems Research
  17. 17 A Shot in the Rear, Not a Shot in the Dark
  18. 18 What Predicts Local Public Health Agency Performance Improvement?
  19. 19 Growth of a Scientific Community of Practice
  20. 20 Evolution of Coauthorship in Public Health Services and Systems Research
  21. 21 Resources that May Matter
  22. 22 Evidence Links Increases in Public Health Spending to Declines in Preventable Deaths
  23. 23 Public Health Financial Management Competencies
  24. 24 Decision Science
  25. 25 Public Health Financial Management Needs
  26. 26 Data-Driven Management Strategies in Public Health Collaboratives
  27. 27 Using Geographic Information Systems to Match Local Health Needs with Public Health Services and Programs
  28. 28 Public Health Systems and Services Research
  29. 29 Local Public Health Capacities to Address the Needs of Culturally and Linguistically Diverse Populations
  30. 30 A Needs Assessment for Data and Methods in Public Health Systems Research
  31. 31 Mapping the Multidisciplinary Field of Public Health Services and Systems Research

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