IDEAS home Printed from https://ideas.repec.org/a/eee/jhecon/v92y2023ics0167629623001005.html
   My bibliography  Save this article

The health effects of nursing home specialization in post-acute care

Author

Listed:
  • Templeton, Zachary S.
  • Apathy, Nate C.
  • Konetzka, R. Tamara
  • Skira, Meghan M.
  • Werner, Rachel M.

Abstract

Nursing homes serve both long-term care and post-acute care (PAC) patients, two groups with distinct financing mechanisms and requirements for care. We examine empirically the effect of nursing home specialization in PAC using 2011–2018 data for Medicare patients admitted to nursing homes following a hospital stay. To address patient selection into specialized nursing homes, we use an instrumental variables approach that exploits variation over time in the distance from the patient's residential ZIP code to the closest nursing home with different levels of PAC specialization. We find that patients admitted to nursing homes more specialized in PAC have lower hospital readmissions and mortality, longer nursing home stays, and higher Medicare spending for the episode of care, suggesting that specialization improves patient outcomes but at higher costs.

Suggested Citation

  • Templeton, Zachary S. & Apathy, Nate C. & Konetzka, R. Tamara & Skira, Meghan M. & Werner, Rachel M., 2023. "The health effects of nursing home specialization in post-acute care," Journal of Health Economics, Elsevier, vol. 92(C).
    • Handle: RePEc:eee:jhecon:v:92:y:2023:i:c:s0167629623001005
    DOI: 10.1016/j.jhealeco.2023.102823
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0167629623001005
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.jhealeco.2023.102823?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Marcelo Coca Perraillon & R. Tamara Konetzka & Daifeng He & Rachel M. Werner, 2019. "Consumer Response to Composite Ratings of Nursing Home Quality," American Journal of Health Economics, University of Chicago Press, vol. 5(2), pages 165-190, Spring.
    2. Imbens, Guido W & Angrist, Joshua D, 1994. "Identification and Estimation of Local Average Treatment Effects," Econometrica, Econometric Society, vol. 62(2), pages 467-475, March.
    3. Magne Mogstad & Alexander Torgovitsky & Christopher R. Walters, 2021. "The Causal Interpretation of Two-Stage Least Squares with Multiple Instrumental Variables," American Economic Review, American Economic Association, vol. 111(11), pages 3663-3698, November.
    4. Rahman, Momotazur & Norton, Edward C. & Grabowski, David C., 2016. "Do hospital-owned skilled nursing facilities provide better post-acute care quality?," Journal of Health Economics, Elsevier, vol. 50(C), pages 36-46.
    5. Jonathan R. Clark & Robert S. Huckman, 2012. "Broadening Focus: Spillovers, Complementarities, and Specialization in the Hospital Industry," Management Science, INFORMS, vol. 58(4), pages 708-722, April.
    6. Werner, Rachel M. & Norton, Edward C. & Konetzka, R. Tamara & Polsky, Daniel, 2012. "Do consumers respond to publicly reported quality information? Evidence from nursing homes," Journal of Health Economics, Elsevier, vol. 31(1), pages 50-61.
    7. Jennifer L. Troyer, 2002. "Cross‐Subsidization in Nursing Homes: Explaining Rate Differentials Among Payer Types," Southern Economic Journal, John Wiley & Sons, vol. 68(4), pages 750-773, April.
    8. R. Konetzka & Edward Norton & Sally Stearns, 2006. "Medicare payment changes and nursing home quality: effects on long-stay residents," International Journal of Health Economics and Management, Springer, vol. 6(3), pages 173-189, September.
    9. Swanson, Ashley, 2021. "Physician investment in hospitals: Specialization, selection, and quality in cardiac care," Journal of Health Economics, Elsevier, vol. 80(C).
    10. 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.
    11. Barro, Jason R. & Huckman, Robert S. & Kessler, Daniel P., 2006. "The effects of cardiac specialty hospitals on the cost and quality of medical care," Journal of Health Economics, Elsevier, vol. 25(4), pages 702-721, July.
    12. Marcelo Coca Perraillon & R. Tamara Konetzka & Daifeng He & Rachel M. Werner, 2019. "Consumer Response to Composite Ratings of Nursing Home Quality," American Journal of Health Economics, MIT Press, vol. 5(2), pages 165-190, Spring.
    13. Martin Gaynor & Harald Seider & William B. Vogt, 2005. "The Volume–Outcome Effect, Scale Economies, and Learning-by-Doing," American Economic Review, American Economic Association, vol. 95(2), pages 243-247, May.
    14. Jennifer L. Troyer, 2002. "Cross-Subsidization in Nursing Homes: Explaining Rate Differentials Among Payer Types," Southern Economic Journal, John Wiley & Sons, vol. 68(4), pages 750-773, April.
    15. Cornell, Portia Y. & Grabowski, David C. & Norton, Edward C. & Rahman, Momotazur, 2019. "Do report cards predict future quality? The case of skilled nursing facilities," Journal of Health Economics, Elsevier, vol. 66(C), pages 208-221.
    16. R. Tamara Konetzka & Fan Yang & Rachel M. Werner, 2019. "Use of instrumental variables for endogenous treatment at the provider level," Health Economics, John Wiley & Sons, Ltd., vol. 28(5), pages 710-716, May.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. 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.
    2. 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.
    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. Joël Cariolle & Yasmine Elkhateeb & Mathilde Maurel, 2022. "(Mis-)information technology: Internet use and perception of democracy in Africa," Documents de travail du Centre d'Economie de la Sorbonne 22010, Université Panthéon-Sorbonne (Paris 1), Centre d'Economie de la Sorbonne.
    5. Robert A. Moffitt & Matthew V. Zahn, 2019. "The Marginal Labor Supply Disincentives of Welfare: Evidence from Administrative Barriers to Participation," NBER Working Papers 26028, National Bureau of Economic Research, Inc.
    6. Suhui Li & Avi Dor, 2013. "How Do Hospitals Respond to Market Entry? Evidence from A Deregulated Market for Cardiac Revascularization," NBER Working Papers 18926, National Bureau of Economic Research, Inc.
    7. Clint Harris, 2022. "Interpreting Instrumental Variable Estimands with Unobserved Treatment Heterogeneity: The Effects of College Education," Papers 2211.13132, arXiv.org.
    8. Tafti, Elena Ashtari, 2023. "Technology, Skills, and Performance: The Case of Robots in Surgery," CINCH Working Paper Series (since 2020) 78746, Duisburg-Essen University Library, DuEPublico.
    9. Nadja van ’t Hoff & Arthur Lewbel & Giovanni Mellace, 2023. "Limited Monotonicity and the Combined Compliers LATE," Boston College Working Papers in Economics 1059, Boston College Department of Economics, revised 25 Apr 2024.
    10. Antonio Vera & Pythagoras Petratos & Torsten Oliver Salge, 2018. "A widening gap? Static and dynamic performance differences between specialist and general hospitals," Health Care Management Science, Springer, vol. 21(1), pages 25-36, March.
    11. Atul Gupta & Sabrina T Howell & Constantine Yannelis & Abhinav Gupta, 2021. "Does Private Equity Investment in Healthcare Benefit Patients? Evidence from Nursing Homes," Working Papers 2021-20, Becker Friedman Institute for Research In Economics.
    12. Cornell, Portia Y. & Grabowski, David C. & Norton, Edward C. & Rahman, Momotazur, 2019. "Do report cards predict future quality? The case of skilled nursing facilities," Journal of Health Economics, Elsevier, vol. 66(C), pages 208-221.
    13. Fusejima, Koki, 2024. "Identification of multi-valued treatment effects with unobserved heterogeneity," Journal of Econometrics, Elsevier, vol. 238(1).
    14. Kim, Tami & Martin, Daniel, 2021. "What do consumers learn from regulator ratings? Evidence from restaurant hygiene quality disclosures," Journal of Economic Behavior & Organization, Elsevier, vol. 185(C), pages 234-249.
    15. Manu Navjeevan & Rodrigo Pinto & Andres Santos, 2023. "Identification and Estimation in a Class of Potential Outcomes Models," Papers 2310.05311, arXiv.org.
    16. Koki Fusejima, 2020. "Identification of multi-valued treatment effects with unobserved heterogeneity," Papers 2010.04385, arXiv.org, revised Apr 2023.
    17. Thomas Carr & Toru Kitagawa, 2021. "Testing Instrument Validity with Covariates," Papers 2112.08092, arXiv.org, revised Sep 2023.
    18. Tommasi, Denni & Zhang, Lina, 2024. "Bounding program benefits when participation is misreported," Journal of Econometrics, Elsevier, vol. 238(1).
    19. Ludwig Kuntz & Stefan Scholtes & Sandra Sülz, 2019. "Separate and Concentrate: Accounting for Patient Complexity in General Hospitals," Management Science, INFORMS, vol. 67(6), pages 2482-2501, June.
    20. Luis Antonio Fantozzi Alvarez & Rodrigo Toneto, 2024. "The interpretation of 2SLS with a continuous instrument: a weighted LATE representation," Working Papers, Department of Economics 2024_11, University of São Paulo (FEA-USP).

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:jhecon:v:92:y:2023:i:c:s0167629623001005. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/locate/inca/505560 .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.