We are witnessing a major shift in philanthropy, which will have a major impact on how charitable dollars are spent to improve healthcare outcomes. Many philanthropists are happy to get the positive press that comes with a large donation and worry very little about what actually becomes of the money. This is not the case with the Bill & Melinda Gates Foundation. It is putting hundreds of millions of dollars into projects that will track and report on the actual improvements that result from charitable gifts.

The foundation made its second large gift to health care tracking this year, a $105 million grant to the University of Washington to measure the impact of public health programs globally. In 2005, the foundation donated $50 million to create the Health Metrics Network with the World Health Organization. Both of these large gifts from the Gates Foundation have similar purposes — to better track the private money spent on health and to use statistical measures to determine the effectiveness of the Foundation’s grant-giving. The 10-year Gates grant to the University of Washington will be combined with $20 million from the University to establish and operate the Institute for Health Metrics and Evaluation in Seattle. The 2005 Gates Foundation health care grant funds programs that generate information on health in developing countries.

The Institute for Health Metrics and Evaluation will collect and analyze data on health trends, such as the prevalence of major diseases and the availability of health services. It will also conduct independent evaluations of the effectiveness of health programs. Institute officials point out that there is an absence of available statistics in global health, particularly in contrast to the available data in business and other sectors. There is a possibility that such health program data is unavailable by design, and that the Institute may face resistance from governments and organizations that want to evade measurement.

The desire for the Gates Foundation to have greater transparency in health care is designed to put pressure on global health care and aid organizations to track and measure each dollar spent and results achieved. Organizations that cannot account for dollars spent and how these dollars benefited the recipients will likely see donors reluctant to make donations.

Because of the role of laboratory testing in early detection, diagnosis, therapeutic decisions, and ongoing monitoring of patient progress, the transparency drive of the Gates Foundation can be expected to increase both the utilization and societal value of laboratory testing. After all, lab test results provide objective benchmarks for validating all types of clinical, operational, and societal improvements.

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