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Nursing Home Quality as a Public Good

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  • David C. Grabowski
  • Jonathan Gruber
  • Joseph J. Angelelli

Abstract

There has been much debate among economists about whether nursing home quality is a public good across Medicaid and private-pay patients within a common facility. However, there has been only limited empirical work addressing this issue. Using a unique individual level panel of residents of nursing homes from seven states, we exploit both within-facility and within-patient variation in payer source and quality to examine this issue. We also test the robustness of these results across states with different Medicaid and private-pay rate differentials. Across our various identification strategies, the results generally support the idea that quality is a public good within nursing homes. That is, within a common nursing home, there is very little evidence to suggest that Medicaid-funded residents receive consistently lower quality care relative to their private-paying counterparts.

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Bibliographic Info

Paper provided by National Bureau of Economic Research, Inc in its series NBER Working Papers with number 12361.

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Date of creation: Jul 2006
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Handle: RePEc:nbr:nberwo:12361

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  1. Paul J. Gertler & Donald M. Waldman, 1990. "Quality Adjusted Cost Functions," NBER Working Papers 3567, National Bureau of Economic Research, Inc.
  2. Louis S. Jacobson & Robert J. LaLonde & Daniel Sullivan, 1992. "Earnings Losses of Displaced Workers," Upjohn Working Papers and Journal Articles 92-11, W.E. Upjohn Institute for Employment Research.
  3. Gertler, Paul J & Waldman, Donald M, 1992. "Quality-Adjusted Cost Functions and Policy Evaluation in the Nursing Home Industry," Journal of Political Economy, University of Chicago Press, vol. 100(6), pages 1232-56, December.
  4. Richard G. Frank, 2004. "Behavioral Economics and Health Economics," NBER Working Papers 10881, National Bureau of Economic Research, Inc.
  5. Freiman, Marc P. & Murtaugh, Christopher M., 1993. "The determinants of the hospitalization of nursing home residents," Journal of Health Economics, Elsevier, vol. 12(3), pages 349-359, October.
  6. Currie, Janet & Gruber, Jonathan, 2001. "Public health insurance and medical treatment: the equalizing impact of the Medicaid expansions," Journal of Public Economics, Elsevier, vol. 82(1), pages 63-89, October.
  7. Joseph G. Altonji & Todd E. Elder & Christopher R. Taber, 2005. "Selection on Observed and Unobserved Variables: Assessing the Effectiveness of Catholic Schools," Journal of Political Economy, University of Chicago Press, vol. 113(1), pages 151-184, February.
  8. Gruber, Jon & Kim, John & Mayzlin, Dina, 1999. "Physician fees and procedure intensity: the case of cesarean delivery," Journal of Health Economics, Elsevier, vol. 18(4), pages 473-490, August.
  9. Jon Gruber & John Kim & Dina Mayzlin, 1998. "Physician Fees and Procedure Intensity: The Case of Cesarean Delivery," NBER Working Papers 6744, National Bureau of Economic Research, Inc.
  10. David C. Grabowski, 2004. "A Longitudinal Study of Medicaid Payment, Private-Pay Price and Nursing Home Quality," International Journal of Health Care Finance and Economics, Springer, vol. 4(1), pages 5-26, 03.
  11. Amitabh Chandra & Jonathan Skinner, 2003. "Geography and Racial Health Disparities," NBER Working Papers 9513, National Bureau of Economic Research, Inc.
  12. 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.
  13. 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.
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Cited by:
  1. Kaestner, Robert & Guardado, Jose, 2008. "Medicare reimbursement, nurse staffing, and patient outcomes," Journal of Health Economics, Elsevier, vol. 27(2), pages 339-361, March.
  2. David C. Grabowski, & David G. Stevenson & Haiden A. Huskamp & Nancy L. Keating, 2005. "The Influence of Medicare Home Health Payment Incentives: Does Payer Source Matter?," PGDA Working Papers 0605, Program on the Global Demography of Aging.

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