. "Appendix C: Analyses of the Sensitivity of the Formula Allocations to Underlying Changes in Input Data." Measuring What Matters: Allocation, Planning, and Quality Assessment for the Ryan White CARE Act. Washington, DC: The National Academies Press, 2004.
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Measuring What Matters: Allocation, Planning, and Quality Assessment for the Ryan White CARE Act
estimates of HIV prevalence and AIDS prevalence provided by the Centers for Disease Control and Prevention (CDC).1 For states with mature name-based HIV reporting systems, estimates of HIV prevalence were based on data from their individual case-reporting systems. For code-based states or states without mature name-based reporting systems, CDC used modeling to produce the HIV prevalence estimates. California and Massachusetts declined to release CDC’s estimates of HIV prevalence, and thus no data were available for these two states. Given that California and Massachusetts did not permit CDC to share CDC’s modeled estimates of HIV prevalence in these states, we imputed the number of HIV cases for these states by assuming that the proportion of HIV to AIDS cases matched the reported proportion in New York. This is an important limitation. The Committee also employed multiple linear regression analysis to identify predictors of RWCA Title I and Title II funding.
In its analyses, the Committee examined “dollar allocations per case” across jurisdictions as a point of departure. The Committee acknowledges that there are many reasons why an equitable system would depart from this standard, including unequal costs of care, unequal need, differences in the efficiency with which jurisdictions apply funds, differences in the quality and comprehensiveness of the existing resource base from one jurisdiction to another, and differences in economies of scale.
In some instances, deviations from the “equal dollars per case” standard will highlight disparities to be corrected; in other instances, they will confirm the view that the system is applying appropriate flexibility to its standards to reflect legitimate differences in need from one jurisdiction to another. Viewed in this light, the Committee’s goal is not to hold up equal dollar allocation as an absolute standard, but rather to make explicit the consequences of allocation formulas that are the product of complex political negotiation, epidemiological evidence, and competing conceptions of fairness.
Despite these limitations, analyses of current allocations are pertinent to stakeholders who wish to anticipate the distributive impact of changes to current formulas. If the current allocation appears unfavorable to states and EMAs that include a high proportion of reported HIV cases to ELCs, the move to a more inclusive definition of HIV burden may have large
The Committee also examined current allocations using estimated AIDS prevalence alone. The differences in allocations using estimated AIDS prevalence and ELCs were not informative, suggesting that any methodological differences between the calculation of ELCs and the calculation of AIDS prevalence is not important for the purposes of identifying allocation variations.