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National health care expenditures constitute revenue to the health care system. However, little is known about how this revenue is distributed across sectors. This article calculates revenues and detailed expenditures for physicians' offices, hospitals, and outpatient care centers in 1997, 2002, 2007, and 2012, using a range of Census Bureau and Bureau of Labor Statistics sources. Between 1997 and 2012, spending on these three sectors rose by $580 billion, and employment rose by 1.7 million people. Just under half of all 2012 revenues were spent on labor compensation. The labor compensation share of spending declined slightly; within these sectors, the share of compensation paid to physicians and nurses increased. Although employment of nonprofessional labor grew during the study period, this group did not account for much of the sector's increased spending. The plurality of the 1997-2012 spending increase went to producers of purchased materials and services, which now account for more than one-third of payments. [ABSTRACT FROM AUTHOR]

The US child population is rapidly becoming more racially and ethnically diverse, yet there are persistent racial/ethnic gaps in child health. Improving and expanding policies to reduce these gaps is increasingly a mandate of government agencies. Identifying effective policies requires a rigorous approach, yet there is a lack of information about which policies improve equity. This article introduces the Policy Equity Assessment, a framework that combines policy assessment and rigorous equity methods to both synthesize existing research and identify and conduct new analyses of policies' ability to reduce racial/ethnic inequities. We applied the Policy Equity Assessment to three policies: Head Start, the Family and Medical Leave Act, and a federal housing assistance program known as Section 8. Our results show racial/ethnic inequities in access to benefits and substantial data and evidence gaps regarding the impact of policies in improving racial/ethnic equity. These results should motivate policy makers to strengthen equity analysis. [ABSTRACT FROM AUTHOR]

Donor nations and philanthropic organizations increasingly require that funds provided for a specific health priority such as HIV should supplement domestic spending on that priority--a concept known as "additionality." We investigated the "additionality" concept using data from Honduras, Rwanda, and Thailand, and we found that the three countries increased funding for HIV in response to increased donor funding. In contrast, the study revealed that donors, faced with increased Global Fund resources for HIV in certain countries, tended to decrease their funding for HIV or shift funds for use in non-HIV health areas. More broadly, we found many problems in the measurement and interpretation of additionality. These findings suggest that it would be preferable for donors and countries to agree on how best to use available domestic and external funds to improve population health, and to develop better means of tracking outcomes, than to try to develop more sophisticated methods to track additionality. [ABSTRACT FROM AUTHOR]

The payment approach known as "pay-for-performance" has been widely adopted with the aim of improving the quality of health care. Nonetheless, little is known about how to use the approach most effectively to improve care. We examined the effects in 260 hospitals of a pay-for-performance demonstration project carried out by the Centers for Medicare and Medicaid Services in partnership with Premier Inc., a nationwide hospital system. We compared these results to those of a control group of 780 hospitals not in the demonstration project. The performance of the hospitals in the project initially improved more than the performance of the control group: More than half of the pay-for- performance hospitals achieved high performance scores, compared to fewer than a third of the control hospitals. However, after five years, the two groups' scores were virtually identical. Improvements were largest among hospitals that were eligible for larger bonuses, were well financed, or operated in less competitive markets. These findings suggest that tailoring pay-for-performance programs to hospitals' specific situations could have the greatest effect on health care quality. [ABSTRACT FROM AUTHOR]