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Higher prices, higher quality? Evidence from German nursing homes

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  • Herr, Annika
  • Hottenrott, Hanna

Abstract

Objectives: This study investigates the relationship between prices and quality of 7,400 German nursing homes controlling for income, nursing home density, demographics, labour market characteristics, and infrastructure at the regional level. Method: We use a cross section of public quality reports for all German nursing homes, which had been evaluated between 2010 and 2013 by external institutions. Our analysis is based on multivariate regressions in a two stage least squares framework, where we instrument prices to explain their effect on quality. Results: Descriptive analysis shows that prices and quality do not only vary across nursing homes, but also across counties and federal states and that quality and prices correlate positively. Second, the econometric analysis, which accounts for the endogenous relation between negotiated price and reported quality, shows that quality indeed positively depends on prices. In addition, more places in nursing homes per people in need are correlated with both lower prices and higher quality. Finally, unobserved factors at the federal state level explain some of the variation of reported quality across nursing homes. Conclusion: Our results suggest that higher prices increase quality. Furthermore, since reported quality and prices vary substantially across federal states, we conclude that the quality and prices of longtermcare facilities may well be compared within federal states but not across.

Suggested Citation

  • Herr, Annika & Hottenrott, Hanna, 2016. "Higher prices, higher quality? Evidence from German nursing homes," DICE Discussion Papers 208, Heinrich Heine University Düsseldorf, Düsseldorf Institute for Competition Economics (DICE).
    • Handle: RePEc:zbw:dicedp:208
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    References listed on IDEAS

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    1. Arndt R. Reichert & Magdalena A. Stroka, 2018. "Nursing home prices and quality of care — Evidence from administrative data," Health Economics, John Wiley & Sons, Ltd., vol. 27(1), pages 129-140, January.
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    7. repec:zbw:rwirep:0470 is not listed on IDEAS
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    11. Herr, Annika & Nguyen, Thu-Van & Schmitz, Hendrik, 2015. "Does quality disclosure improve quality? Responses to the introduction of nursing home report cards in Germany," DICE Discussion Papers 176, Heinrich Heine University Düsseldorf, Düsseldorf Institute for Competition Economics (DICE).
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    Cited by:

    1. Arndt R. Reichert & Magdalena A. Stroka, 2018. "Nursing home prices and quality of care — Evidence from administrative data," Health Economics, John Wiley & Sons, Ltd., vol. 27(1), pages 129-140, January.
    2. Herr, A. & Saric, A., 2016. "The Welfare Effects of Single Rooms in German Nursing Homes: A Structural Approach," Health, Econometrics and Data Group (HEDG) Working Papers 16/23, HEDG, c/o Department of Economics, University of York.
    3. 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.
    4. Anna Goeddeke & Justus Haucap & Annika Herr & Christian Wey, 2018. "Flexibility in Wage Setting Under the Threat of Relocation," LABOUR, CEIS, vol. 32(1), pages 1-22, March.
    5. Cristina Vilaplana-Prieto & Carmelo S. Gómez Martínez & Paloma Echevarría Pérez & Isabel Legaz, 2023. "Sociosanitary Legal and Economic Aspects in Nursing Homes for the Elderly in Spain," IJERPH, MDPI, vol. 20(6), pages 1-24, March.
    6. Céline Bonnet & Jan Philip Schain, 2020. "An Empirical Analysis Of Mergers: Efficiency Gains And Impact On Consumer Prices," Journal of Competition Law and Economics, Oxford University Press, vol. 16(1), pages 1-35.
    7. Herr, Annika & Nguyen, Thu-Van & Schmitz, Hendrik, 2016. "Public reporting and the quality of care of German nursing homes," Health Policy, Elsevier, vol. 120(10), pages 1162-1170.
    8. Cutler, Henry & Gu, Yuanyuan & Bilgrami, Anam & Partington, Andrew, 2023. "The 2021 proposal to increase market forces in the Australian residential aged-care sector," Health Policy, Elsevier, vol. 127(C), pages 60-65.
    9. Dörte Heger & Annika Herr & Anne Mensen, 2022. "Paying for the view? How nursing home prices affect certified staffing ratios," Health Economics, John Wiley & Sons, Ltd., vol. 31(8), pages 1618-1632, August.

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    More about this item

    Keywords

    nursing homes; care quality; price; long-term care; two-stage least squares;
    All these keywords.

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • L11 - Industrial Organization - - Market Structure, Firm Strategy, and Market Performance - - - Production, Pricing, and Market Structure; Size Distribution of Firms
    • L15 - Industrial Organization - - Market Structure, Firm Strategy, and Market Performance - - - Information and Product Quality
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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