One in every five dollars will be devoted to health care by 2015, with spending reaching more than $4 trillion, federal forecasters predict in a Health Affairs February 22 Web Exclusive. In their annual projection on health care trends, the Centers for Medicare and Medicaid Services (CMS) predicts that health spending will consistently outpace the growth in the gross domestic product (GDP) over the next 10 years. Compared to last year's projections, CMS sees faster growth for hospital spending and slower growth for drug spending.

In the January/February Health Affairs, Len Nichols and Anne O'Malley outline three possible futures for hospital payment. They say that "utopia" - exclusively performance-based payment - could come about only if Medicare and private payers agree on a common payment system, and if public and private payers find ways to share the gains from increased hospital efficiency and quality with the physicians who make most care decisions inside and outside hospitals. Nichols and O'Malley suggest that slow progress on pay-for-performance is most likely, but that stagnation at the status quo is possible, too.

In a January/February Health Affairs Grantwatch Essay, Susan Hassmiller and Maureen Cozine describe the Robert Wood Johnson Foundation's support for efforts to combat the nursing shortage by fundamentally transforming the way that care is delivered at the bedside in hospitals. One example: allowing nurses to call on "rapid response teams" of clinicians, thus validating nurses' professional judgment while preventing patients from deteriorating.