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Quantifying the Impacts of Limited Supply: The Case of Nursing Homes

Author

Listed:
  • Andrew Ching
  • Fumiko Hayashi
  • Hui Wang

Abstract

This paper develops a new estimation method that accounts for excess demand and the unobserved component of product quality. We apply our method to study the Wisconsin nursing home market in 1999, and find that nearly 20% of elderly qualified for Medicaid were rationed out. However, our counterfactual experiment shows that the net welfare gain of fulfilling all nursing home demands may be small, because the welfare gain to Medicaid patients could be largely offset by the increase in Medicaid expenditures. We also find that a 1% increase in quality would crowd out 3.2% Medicaid patients in binding nursing homes.

Suggested Citation

  • Andrew Ching & Fumiko Hayashi & Hui Wang, 2015. "Quantifying the Impacts of Limited Supply: The Case of Nursing Homes," Working Papers 150006, Canadian Centre for Health Economics.
    • Handle: RePEc:cch:wpaper:150006
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    Cited by:

    1. Martin B. Hackmann & R. Vincent Pohl & Nicolas R. Ziebarth, 2024. "Patient versus Provider Incentives in Long-Term Care," American Economic Journal: Applied Economics, American Economic Association, vol. 16(3), pages 178-218, July.
    2. Richards-Shubik, Seth & Roberts, Mark S. & Donohue, Julie M., 2022. "Measuring quality effects in equilibrium," Journal of Health Economics, Elsevier, vol. 83(C).
    3. Bar, M.; & Bakx, P.; & Wouterse, B.; & van Doorslaer, Eddy.;, 2022. "Estimating the health value added by nursing homes," Health, Econometrics and Data Group (HEDG) Working Papers 22/12, HEDG, c/o Department of Economics, University of York.
    4. David Berger & Kyle Herkenhoff & Simon Mongey, 2025. "Minimum Wages, Efficiency, and Welfare," Econometrica, Econometric Society, vol. 93(1), pages 265-301, January.
    5. Martin Benjamin Hackmann & R. Vincent Pohl, 2018. "Patient vs. Provider Incentives in Long-Term Care," CESifo Working Paper Series 7373, CESifo.
    6. David W. Berger & Kyle F. Herkenhoff & Simon Mongey, 2022. "Minimum Wages, Efficiency and Welfare," NBER Working Papers 29662, National Bureau of Economic Research, Inc.
    7. Robert L. Ohsfeldt & Pengxiang Li, 2018. "State entry regulation and home health agency quality ratings," Journal of Regulatory Economics, Springer, vol. 53(1), pages 1-19, February.
    8. Nikhil Agarwal & Paulo J. Somaini, 2022. "Demand Analysis under Latent Choice Constraints," NBER Working Papers 29993, National Bureau of Economic Research, Inc.
    9. Tatyana Koreshkova & Minjoon Lee, 2020. "Nursing Homes in Equilibrium: Implications for Long-term Care Policies," Working Papers wp414, University of Michigan, Michigan Retirement Research Center.
    10. Bär, Marlies & Bakx, Pieter & Wouterse, Bram & van Doorslaer, Eddy, 2022. "Estimating the health value added by nursing homes," Journal of Economic Behavior & Organization, Elsevier, vol. 203(C), pages 1-23.
    11. Heger, Dörte & Herr, Annika & Lückemann, Maximilian & Reichert, Arndt R. & Tycher, Leonie, 2023. "Strategies and implications of mitigating personnel shortages in nursing homes," Ruhr Economic Papers 1056, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.
    12. Tongil “TI” Kim & Diwas KC, 2020. "The Impact of Hospital Advertising on Patient Demand and Health Outcomes," Marketing Science, INFORMS, vol. 39(3), pages 612-635, May.
    13. Hegland, Thomas A., 2025. "Nursing home payroll subsidies and the trade-off between staffing and access to care for Medicaid enrollees," Journal of Health Economics, Elsevier, vol. 103(C).
    14. Rainer Kotschy & David E. Bloom, 2022. "A Comparative Perspective on Long-Term Care Systems," NBER Working Papers 29951, National Bureau of Economic Research, Inc.
    15. Haizhen Lin, 2015. "Quality Choice And Market Structure: A Dynamic Analysis Of Nursing Home Oligopolies," International Economic Review, Department of Economics, University of Pennsylvania and Osaka University Institute of Social and Economic Research Association, vol. 56(4), pages 1261-1290, November.
    16. Nishimura, Y.; Oikawa, M.;, 2017. "Effects of Informal Elderly Care on Labor Supply: Exploitation of Government Intervention on the Supply Side of Elderly Care Market," Health, Econometrics and Data Group (HEDG) Working Papers 17/02, HEDG, c/o Department of Economics, University of York.
    17. Shinya Sugawara, 2017. "Firm‐Driven Management of Longevity Risk: Analysis of Lump‐Sum Forward Payments in Japanese Nursing Homes," Journal of Economics & Management Strategy, Wiley Blackwell, vol. 26(1), pages 169-204, February.
    18. Susan Feng Lu & Konstantinos Serfes & Gerard Wedig & Bingxiao Wu, 2021. "Does Competition Improve Service Quality? The Case of Nursing Homes Where Public and Private Payers Coexist," Management Science, INFORMS, vol. 67(10), pages 6493-6512, October.
    19. Martin B. Hackmann, 2019. "Incentivizing Better Quality of Care: The Role of Medicaid and Competition in the Nursing Home Industry," American Economic Review, American Economic Association, vol. 109(5), pages 1684-1716, May.

    More about this item

    Keywords

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    JEL classification:

    • C15 - Mathematical and Quantitative Methods - - Econometric and Statistical Methods and Methodology: General - - - Statistical Simulation Methods: General
    • C35 - Mathematical and Quantitative Methods - - Multiple or Simultaneous Equation Models; Multiple Variables - - - Discrete Regression and Qualitative Choice Models; Discrete Regressors; Proportions
    • D45 - Microeconomics - - Market Structure, Pricing, and Design - - - Rationing; Licensing
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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