Each fall, just as the government's new fiscal year is starting (October 1), federal departments and agencies with mandates in public health turn their attention to the future once again, and begin to estimate how much they might spend on domestic and international health programs a year from now, at the start of the next fiscal year. The process is part of the much larger annual process of setting the entire federal budget for all government spending. In 2004, that budget stood at $2.34 trillion.

Like the health sector itself, budgeting for health-related spending is a fragmented undertaking. Many people and committees in the executive and legislative branches (and, on rare occasions, in the judiciary) can influence health-spending policy, but no single entity controls it.

The annual budget cycle follows a specific path, however, and the U.S. government's response to international pressures and crises are incorporated within it, although in extreme or urgent cases, some parts of the process may be sidestepped to make resources available more quickly. The outcome of the regular process is a budget for each of the government's health-related agencies, programs, and special initiatives.

Along the way there are key points where individuals and organizations outside the government can influence the outcome by providing various kinds of input: research, data, testimony at hearings, or direct lobbying of elected representatives. A primary purpose of this article is to offer information about these points of influence and how they work.

To learn more about the entire process, read on, or click on each step of the process as shown in the following pages.

Intro | Stage: 1 | 2 | 3 | 4a | 4b | 5 | Sources