Federal Funding

Let me quasi-quote myself (from a forthcoming editorial) ~

Within the U.S. Department of Health and Human Services (DHHS), five agencies are likely to address health care management: the Agency for Health Care Research and Quality (AHRQ), the National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), the Health Resources and Services Administration’s (HRSA), and the Centers for Medicare and Medicaid Services (CMS). These five, I’ll call them the Big 5, receive considerable federal funding for research, health care reimbursement, and training. The NIH budget of $30.6 billion (FY 2009 Budget) is nearly four times CDC’s $8.8 billion and HRSA’s $7.5 billion budgets for Fiscal Year 2010, and dwarfs AHRQ’s $372 million budget request for fiscal year 2010. The CMS 2010 Fiscal Year budget was $818 billion, of which $811 billion was earmarked for health insurance and long term care.

These numbers are profoundly staggering. Except for CMS, which is essentially federal health insurance for the elderly and the poor, the agencies focus on improving health care services. I don't quibble with the amounts, but only wish that more of the funds would be for prevention of disease rather than for treatment. I also wish that more of the money would go toward services and programs that are population-focused. One could argue that is the case with Medicaid, but it boils down to reimbursement for individual care.

These issues are on my mind as I struggle with the local health departments to figure out how to aligng funding with prevention and population-focused practice. When I look at the budget numbers, I see possibilities but not motivation. I can only wonder what the future will hold and how much of the future I might be able to shape.