Effect of nursing home ownership on the quality of post-acute care: An instrumental variables approach
Given the preferential tax treatment afforded nonprofit firms, policymakers and researchers have been interested in whether the nonprofit sector provides higher nursing home quality relative to its for-profit counterpart. However, differential selection into for-profits and nonprofits can lead to bi...
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| Veröffentlicht in: | Journal of health economics 2013-01, Vol.32 (1), p.12-21 |
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| creator | Grabowski, David C. Feng, Zhanlian Hirth, Richard Rahman, Momotazur Mor, Vincent |
| description | Given the preferential tax treatment afforded nonprofit firms, policymakers and researchers have been interested in whether the nonprofit sector provides higher nursing home quality relative to its for-profit counterpart. However, differential selection into for-profits and nonprofits can lead to biased estimates of the effect of ownership form. By using “differential distance” to the nearest nonprofit nursing home relative to the nearest for-profit nursing home, we mimic randomization of residents into more or less “exposure” to nonprofit homes when estimating the effects of ownership on quality of care. Using national Minimum Data Set assessments linked with Medicare claims, we use a national cohort of post-acute patients who were newly admitted to nursing homes within an 18-month period spanning January 1, 2004 and June 30, 2005. After instrumenting for ownership status, we found that post-acute patients in nonprofit facilities had fewer 30-day hospitalizations and greater improvement in mobility, pain, and functioning. |
| doi_str_mv | 10.1016/j.jhealeco.2012.08.007 |
| format | Article |
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However, differential selection into for-profits and nonprofits can lead to biased estimates of the effect of ownership form. By using “differential distance” to the nearest nonprofit nursing home relative to the nearest for-profit nursing home, we mimic randomization of residents into more or less “exposure” to nonprofit homes when estimating the effects of ownership on quality of care. Using national Minimum Data Set assessments linked with Medicare claims, we use a national cohort of post-acute patients who were newly admitted to nursing homes within an 18-month period spanning January 1, 2004 and June 30, 2005. 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However, differential selection into for-profits and nonprofits can lead to biased estimates of the effect of ownership form. By using “differential distance” to the nearest nonprofit nursing home relative to the nearest for-profit nursing home, we mimic randomization of residents into more or less “exposure” to nonprofit homes when estimating the effects of ownership on quality of care. Using national Minimum Data Set assessments linked with Medicare claims, we use a national cohort of post-acute patients who were newly admitted to nursing homes within an 18-month period spanning January 1, 2004 and June 30, 2005. After instrumenting for ownership status, we found that post-acute patients in nonprofit facilities had fewer 30-day hospitalizations and greater improvement in mobility, pain, and functioning.</description><subject>Acute Disease - rehabilitation</subject><subject>Acute Disease - therapy</subject><subject>Aged, 80 and over</subject><subject>Bias</subject><subject>Estimation</subject><subject>Female</subject><subject>Health administration</subject><subject>Health economics</subject><subject>Health Facilities, Proprietary - economics</subject><subject>Health Facilities, Proprietary - standards</subject><subject>Health Facilities, Proprietary - statistics & numerical data</subject><subject>Hospitalization</subject><subject>Humans</subject><subject>Male</subject><subject>Medicare</subject><subject>Medicare - economics</subject><subject>Medicare - statistics & numerical data</subject><subject>Nursing homes</subject><subject>Nursing Homes - economics</subject><subject>Nursing Homes - organization & administration</subject><subject>Nursing Homes - standards</subject><subject>Organizations, Nonprofit - economics</subject><subject>Organizations, Nonprofit - standards</subject><subject>Organizations, Nonprofit - statistics & numerical data</subject><subject>Ownership</subject><subject>Ownership - economics</subject><subject>Ownership - statistics & numerical data</subject><subject>Policy making</subject><subject>Post-acute care</subject><subject>Quality</subject><subject>Quality Indicators, Health Care - economics</subject><subject>Quality Indicators, Health Care - statistics & numerical data</subject><subject>Quality of care</subject><subject>Quality of Health Care - economics</subject><subject>Quality of Health Care - statistics & numerical data</subject><subject>Studies</subject><subject>Subacute care</subject><subject>United States</subject><issn>0167-6296</issn><issn>1879-1646</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>7QJ</sourceid><recordid>eNqNkctu1DAUQCMEotPCL1SW2LBJ8COxHRaIqioFqRIbWFuOc904SuzUTqbq3-PRtBWwAS_shc99nqI4J7gimPAPYzUOoCcwoaKY0ArLCmPxotgRKdqS8Jq_LHYZFCWnLT8pTlMacT4Na18XJ5RRTGnDdoW9shbMioJFfovJ-Vs0hBlQuPcQ0-AWFDxaB0B3m57c-nAAl5DWUpttBWR0hI_owiPn0xq3GfyqJ7TX0elugoT0ssSgzfCmeGX1lODt43tW_Pxy9ePya3nz_frb5cVNaZqWr_nWVIAgugeBW6o7C8IwrmsrLOOyty3rjQTemY60jekFs03PmjxmbTpMDDsrPh3zLls3Q29yP1FPaolu1vFBBe3Unz_eDeo27BVrmGypzAnePyaI4W6DtKrZJQPTpD2ELSlCZaYIrf8HFYw2rWQso-_-QsewRZ83kSkuRCtpU2eKHykTQ0oR7HPfBKuDdTWqJ-vqYF1hqbL1HHj--9TPYU-aM_D5CEDe_d5BVMk48AZ6F7N91Qf3rxq_APM3w2g</recordid><startdate>20130101</startdate><enddate>20130101</enddate><creator>Grabowski, David C.</creator><creator>Feng, Zhanlian</creator><creator>Hirth, Richard</creator><creator>Rahman, Momotazur</creator><creator>Mor, Vincent</creator><general>Elsevier B.V</general><general>Elsevier Sequoia S.A</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QJ</scope><scope>7T2</scope><scope>8BJ</scope><scope>C1K</scope><scope>FQK</scope><scope>JBE</scope><scope>K9.</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20130101</creationdate><title>Effect of nursing home ownership on the quality of post-acute care: An instrumental variables approach</title><author>Grabowski, David C. ; 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| source | Elsevier ScienceDirect Journals Complete - AutoHoldings; MEDLINE; Applied Social Sciences Index & Abstracts (ASSIA) |
| subjects | Acute Disease - rehabilitation Acute Disease - therapy Aged, 80 and over Bias Estimation Female Health administration Health economics Health Facilities, Proprietary - economics Health Facilities, Proprietary - standards Health Facilities, Proprietary - statistics & numerical data Hospitalization Humans Male Medicare Medicare - economics Medicare - statistics & numerical data Nursing homes Nursing Homes - economics Nursing Homes - organization & administration Nursing Homes - standards Organizations, Nonprofit - economics Organizations, Nonprofit - standards Organizations, Nonprofit - statistics & numerical data Ownership Ownership - economics Ownership - statistics & numerical data Policy making Post-acute care Quality Quality Indicators, Health Care - economics Quality Indicators, Health Care - statistics & numerical data Quality of care Quality of Health Care - economics Quality of Health Care - statistics & numerical data Studies Subacute care United States |
| title | Effect of nursing home ownership on the quality of post-acute care: An instrumental variables approach |
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