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Medicare payment changes and nursing home quality: effects on long-stay residents

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Author Info
R. Konetzka ()
Edward Norton
Sally Stearns

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Abstract

The Balanced Budget Act of 1997 dramatically changed the way that Medicare pays skilled nursing facilities, providing a natural experiment in nursing home behavior. Medicare payment policy (directed at short-stay residents) may have affected outcomes for long-stay, chronic-care residents if services for these residents were subsidized through cost-shifting prior to implementation of Medicare prospective payment for nursing homes. We link changes in both the form and level of Medicare payment at the facility level with changes in resident-level quality, as represented by pressure sores and urinary tract infections in Minimum Data Set (MDS) assessments. Results show that long-stay residents experienced increased adverse outcomes with the elimination of Medicare cost reimbursement. Copyright Springer Science+Business Media, LLC 2006

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File URL: http://hdl.handle.net/10.1007/s10754-006-9000-9
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Publisher Info
Article provided by Springer in its journal International Journal of Health Care Finance and Economics.

Volume (Year): 6 (2006)
Issue (Month): 3 (September)
Pages: 173-189
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Handle: RePEc:kap:ijhcfe:v:6:y:2006:i:3:p:173-189

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Web page: http://www.springerlink.com/link.asp?id=106603

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Related research
Keywords: Prospective payment; Nursing homes; Medicare; Quality of care; I11; I18; H51;

References listed on IDEAS
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  1. Jennifer L. Troyer, 2002. "Cross-Subsidization in Nursing Homes: Explaining Rate Differentials Among Payer Types," Southern Economic Journal, Southern Economic Association, vol. 68(4), pages 750-773, April.
  2. Norton, Edward C., 2000. "Long-term care," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 17, pages 955-994 Elsevier. [Downloadable!] (restricted)
  3. Grabowski, David C., 2001. "Medicaid reimbursement and the quality of nursing home care," Journal of Health Economics, Elsevier, vol. 20(4), pages 549-569, July. [Downloadable!] (restricted)
  4. Cutler, David M, 1995. "The Incidence of Adverse Medical Outcomes under Prospective Payment," Econometrica, Econometric Society, vol. 63(1), pages 29-50, January. [Downloadable!] (restricted)
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  5. Edward C. Norton & Courtney Harold Van Houtven & Richard C. Lindrooth & Sharon-Lise T. Normand & Barbara Dickey, 2002. "Does prospective payment reduce inpatient length of stay?," Health Economics, John Wiley & Sons, Ltd., vol. 11(5), pages 377-387. [Downloadable!]
  6. Ai, Chunrong & Norton, Edward C., 2003. "Interaction terms in logit and probit models," Economics Letters, Elsevier, vol. 80(1), pages 123-129, July. [Downloadable!] (restricted)
  7. 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. [Downloadable!] (restricted)
  8. Dranove, David, 1988. "Pricing by non-profit institutions : The case of hospital cost-shifting," Journal of Health Economics, Elsevier, vol. 7(1), pages 47-57, March. [Downloadable!] (restricted)
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