How can hospitals adapt to today's competitive marketplace while continuing to provide comprehensive health care to all? That's one of the primary questions raised in "U.S. Hospitals: Mission vs. Market," the January-February issue of Health Affairs.

A significant decline in prescription drug spending growth helped slow the pace of U.S. health spending to its lowest level in four years, according to a report by actuaries at the Centers for Medicare and Medicaid Services published in the January-February issue of Health Affairs. National health care spending grew 7.9 percent in 2004, down from 8.2 percent in 2003 and drug spending slowed to single digits or the first time in a decade, rising 8.2 percent.

As the United States enters its ninth consecutive year of a nurse shortage, new research presented in the January-February issue of Health Affairs shows that if hospitals increased their use of registered nurses (RNs) and hours of nursing care per patient, more than 6,700 patient deaths and 4 million days of care in hospitals could be avoided each year. For hospitals using both RNs and licensed practical nurses (LPNs), greater use of RNs appears to pay for itself in fewer patient deaths, reduced lengths of hospital stay, and decreased rates of complications such as urinary tract infections and pneumonia.