HLTH 4530 Week 6 Budget Scenario Paper Example

One Grant, Three Programs, Money for About Two: Full Funding for Heat Response, the Highest-Risk Tier of a Home Falls Program and Nothing From This Pot for Naloxone, With the Criteria Stated First

Student Name

Walden University

HLTH 4530: Healthcare Economics From a Population Health Perspective

Instructor Name

Month Day, Year

One Grant, Three Programs, Money for About Two: Full Funding for Heat Response, the Highest-Risk Tier of a Home Falls Program and Nothing From This Pot for Naloxone, With the Criteria Stated First

The Scenario

The Halvorsen County Board of Health, a composite county board serving about 310,000 residents, has received a one-time state grant to be spent over two years on injury and death prevention. The grant is a fixed total; this paper describes how it is divided in shares rather than in dollars, because the decision turns on proportions and priorities, not on the size of the sum. Three programs have applied, each worthwhile and each able to absorb most of the grant on its own:

1. Heat response: cooling centers in libraries and senior centers during heat advisories, transportation to them, and door-to-door and telephone checks on older residents who live alone.

2. Falls prevention: home safety assessments by occupational therapists for adults aged 65 and older, with grab bars, lighting and removal of trip hazards.

3. Naloxone distribution: free nasal naloxone kits and brief training for people who use opioids, their families and staff at shelters and libraries.

The grant can fund roughly two of the three in full.

Criteria, Stated in Advance

Three criteria are applied, in order of weight, before any program is scored:

1. The size of the population at risk in the county and the severity of the harm the program addresses.

2. The strength of the evidence that the program reduces that harm.

3. Whether another funder is likely to pay for the program if this grant does not.

The third criterion matters because the board's question is not which program is best in the abstract but where this particular money adds the most that would not otherwise happen. Money that displaces another funder buys nothing new.

Allocation

Table 1

Allocation of the Grant Across the Three Programs

Shares are approximate; the county is composite and the programs are described at the level of their design.

Justification

Heat Response: Fully Funded

Heat response meets the first criterion strongly in a county whose older population is growing and whose summers have brought more heat advisories. Its evidence comes from the 1995 Chicago heat wave. In a case-control study of 339 deaths and 339 matched controls, Semenza et al. (1996) identified bed confinement and solitary living as the heaviest risks, while having a working air conditioner or a way to get around each lowered it substantially. The program targets exactly those factors: transportation to cooled spaces and checks on people who live alone. No other funder covers it in Halvorsen County. It is funded in full.

Falls Prevention: Partially Funded, Highest-Risk Tier

Falls among older adults are common and costly, and the evidence for home safety work is strong. In a Cochrane review of 159 trials, Gillespie et al. (2012) found that home safety assessment and modification reduced the rate of falls and that these interventions were more effective in people at higher risk of falling, including those with severe visual impairment. That finding shapes the allocation. Rather than spread assessments thinly across all residents over 65, the grant funds the tier in which each assessment is most likely to prevent a fall: people who have already fallen or who have severe vision loss. Some costs may also be billed to Medicare for eligible patients, which stretches the share further.

Naloxone Distribution: Not Funded From This Grant

Naloxone distribution addresses the most severe harm of the three, death, and it has supporting evidence. Walley et al. (2013) studied 19 Massachusetts communities and found that overdose death rates were lower where overdose education and nasal naloxone distribution had been implemented, with larger reductions where enrollment was higher. On the first two criteria, naloxone would rank high.

It fails the third criterion. Halvorsen County, like many local governments, now receives payments from the national opioid litigation settlements, and naloxone distribution is among the most common and widely accepted uses of those funds. Many states now require local governments to report how they spend settlement payments (Lindenfeld et al., 2026), which makes it possible for the board to confirm that naloxone is funded. Spending this grant on naloxone would largely replace settlement money rather than add to it.

What Goes Unfunded

The decision leaves real gaps, and they should be named. Falls assessments for lower-risk older adults, those who have not yet fallen, are not funded, even though some of them will fall before the next funding cycle. The heat program does not include air conditioner distribution, which the Chicago evidence suggests would help but which costs more per person than the grant allows. And if the county's settlement payments are diverted or delayed, naloxone distribution will have no backup from this grant. The board should ask its opioid settlement committee to confirm naloxone funding in writing before final approval.

How the Decision Would Change

The allocation depends on facts that could change before the grant is spent, and the board should know in advance which changes would reverse it. If the county's settlement committee commits its payments to other uses, such as treatment programs or law enforcement, naloxone would lose its other funder and should move ahead of the lower falls tier. If a utility assistance program begins paying for home air conditioning for older residents, part of the heat share could move to falls prevention. And if the state issues a second round of grants for heat response, as some states have after severe summers, the heat program's share should be reconsidered. Writing these conditions into the board's decision makes the third criterion visible to the public and gives the board a way to revisit the allocation without starting over.

Limits

The county and its programs are composite. The evidence for each program comes from different study designs, a case-control study, a systematic review of trials and an interrupted time series, so the programs are not compared on a common measure of health gained per dollar. A formal cost-effectiveness analysis would sharpen the comparison but would not remove the role of the third criterion, which turns on the county's own mix of funders.

References

Gillespie, L. D., Robertson, M. C., Gillespie, W. J., Sherrington, C., Gates, S., Clemson, L. M., & Lamb, S. E. (2012). Interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews, (9), Article CD007146. https://doi.org/10.1002/14651858.CD007146.pub3

Lindenfeld, Z., Mauri, A. I., & Winiker, A. K. (2026). Rating the quality and consistency of local opioid settlement expenditure data. Journal of Addiction Medicine, 20(5), 626-628. https://doi.org/10.1097/ADM.0000000000001653

Semenza, J. C., Rubin, C. H., Falter, K. H., Selanikio, J. D., Flanders, W. D., Howe, H. L., & Wilhelm, J. L. (1996). Heat-related deaths during the July 1995 heat wave in Chicago. New England Journal of Medicine, 335(2), 84-90. https://doi.org/10.1056/NEJM199607113350203

Walley, A. Y., Xuan, Z., Hackman, H. H., Quinn, E., Doe-Simkins, M., Sorensen-Alawad, A., Ruiz, S., & Ozonoff, A. (2013). Opioid overdose rates and implementation of overdose education and nasal naloxone distribution in Massachusetts: Interrupted time series analysis. BMJ, 346, f174. https://doi.org/10.1136/bmj.f174