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Technical efficiency of nursing homes: do five-star quality ratings matter?

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  • Rajendra Dulal

    (Stanford School of Medicine)

Abstract

This study investigates associations between five-star quality ratings and technical efficiency of nursing homes. The sample consists of a balanced panel of 338 nursing homes in California from 2009 through 2013 and uses two-stage data envelopment (DEA) analysis. The first-stage applies an input oriented variable returns to scale DEA analysis. The second-stage uses a left censored random-effect Tobit regression model. The five-star quality ratings i.e., health inspections, quality measures, staffing available on the Nursing Home Compare website are divided into two categories: outcome and structure form of quality. Results show that quality measures ratings and health inspection ratings, used as outcome form of quality, are not associated with mean technical efficiency. These quality ratings, however, do affect the technical efficiency of a particular nursing home and hence alter the ranking of nursing homes based on efficiency scores. Staffing rating, categorized as a structural form of quality, is negatively associated with mean technical efficiency. These findings show that quality dimensions are associated with technical efficiency in different ways, suggesting that multiple dimensions of quality should be included in the efficiency analysis of nursing homes. They also suggest that patient care can be enhanced through investing more in improving care delivery rather than simply raising the number of staff per resident.

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  • Rajendra Dulal, 2018. "Technical efficiency of nursing homes: do five-star quality ratings matter?," Health Care Management Science, Springer, vol. 21(3), pages 393-400, September.
    • Handle: RePEc:kap:hcarem:v:21:y:2018:i:3:d:10.1007_s10729-017-9392-8
    DOI: 10.1007/s10729-017-9392-8
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    1. Herr, Annika & Hottenrott, Hanna, 2016. "Higher prices, higher quality? Evidence from German nursing homes," Health Policy, Elsevier, vol. 120(2), pages 179-189.
    2. Bruce Hollingsworth, 2008. "The measurement of efficiency and productivity of health care delivery," Health Economics, John Wiley & Sons, Ltd., vol. 17(10), pages 1107-1128, October.
    3. Anna A. Amirkhanyan & Hyun Joon Kim & Kristina T. Lambright, 2008. "Does the public sector outperform the nonprofit and for-profit sectors? Evidence from a national panel study on nursing home quality and access," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 27(2), pages 326-353.
    4. Gary Ferrier & Julie Trivitt, 2013. "Incorporating quality into the measurement of hospital efficiency: a double DEA approach," Journal of Productivity Analysis, Springer, vol. 40(3), pages 337-355, December.
    5. Cohen, Joel W. & Spector, William D., 1996. "The effect of Medicaid reimbursement on quality of care in nursing homes," Journal of Health Economics, Elsevier, vol. 15(1), pages 23-48, February.
    6. Lorin M. Hitt & Prasanna Tambe, 2016. "Health Care Information Technology, Work Organization, and Nursing Home Performance," ILR Review, Cornell University, ILR School, vol. 69(4), pages 834-859, August.
    7. Shyr-Juh Chang & Mei-Ai Cheng, 2013. "The impact of nursing quality on nursing home efficiency: evidence from Taiwan," Review of Accounting and Finance, Emerald Group Publishing Limited, vol. 12(4), pages 369-386, October.
    8. William Greene, 2004. "Distinguishing between heterogeneity and inefficiency: stochastic frontier analysis of the World Health Organization's panel data on national health care systems," Health Economics, John Wiley & Sons, Ltd., vol. 13(10), pages 959-980, October.
    9. Richard Hirth & David Grabowski & Zhanlian Feng & Momotazur Rahman & Vincent Mor, 2014. "Effect of nursing home ownership on hospitalization of long-stay residents: an instrumental variables approach," International Journal of Health Economics and Management, Springer, vol. 14(1), pages 1-18, March.
    10. Simar, Leopold & Wilson, Paul W., 2007. "Estimation and inference in two-stage, semi-parametric models of production processes," Journal of Econometrics, Elsevier, vol. 136(1), pages 31-64, January.
    11. Yasar A. Ozcan, 2014. "Evaluation of Performance in Health Care," International Series in Operations Research & Management Science, in: Health Care Benchmarking and Performance Evaluation, edition 2, chapter 0, pages 3-14, Springer.
    12. Newhouse, Joseph P., 1994. "Frontier estimation: How useful a tool for health economics?," Journal of Health Economics, Elsevier, vol. 13(3), pages 317-322, October.
    13. Giulia Garavaglia & Emanuele Lettieri & Tommaso Agasisti & Silvano Lopez, 2011. "Efficiency and quality of care in nursing homes: an Italian case study," Health Care Management Science, Springer, vol. 14(1), pages 22-35, March.
    14. Grabowski, David C. & Feng, Zhanlian & Hirth, Richard & Rahman, Momotazur & Mor, Vincent, 2013. "Effect of nursing home ownership on the quality of post-acute care: An instrumental variables approach," Journal of Health Economics, Elsevier, vol. 32(1), pages 12-21.
    15. Yasar A. Ozcan, 2014. "Health Care Benchmarking and Performance Evaluation," International Series in Operations Research and Management Science, Springer, edition 2, number 978-1-4899-7472-3, September.
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    2. Alice Tran & Kim-Huong Nguyen & Len Gray & Tracy Comans, 2019. "A Systematic Literature Review of Efficiency Measurement in Nursing Homes," IJERPH, MDPI, vol. 16(12), pages 1-18, June.

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