Maryland’s global budget for rural hospitals specifies the total amount of revenue acute-care hospitals can receive from all public and private payers. But despite hopes it would reduce hospital use as well as spending, a Commonwealth Fund–supported study in Health Affairs (Apr. 2018) by the University of Pittsburgh’s Eric T. Roberts and colleagues found it did neither, when compared to a control group. Learn the possible reasons why, and read a companion post by the Commonwealth Fund’s Arnav Shah, Shawn Bishop, Christina Ramsay, and Eric Schneider, M.D., to understand global budgets in the context of other payment reform initiatives.