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Cost efficiency of nursing homes: do five-star quality ratings matter?

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  • Rajendra Dulal

    (Wayne State University)

Abstract

Nursing homes may respond to the pressure to reduce costs by reducing quality of care, so the two are related. This study examines the determinants of nursing home costs and cost efficiency, and investigates how various measures of nursing home care quality influence both of these. It applies a one-step stochastic frontier approach to a large panel of California nursing homes surveyed between 2009 and 2013. Quality is measured by three different ratings available on the Nursing Home Compare website: rating on quality measures, rating on the health inspection, and rating on staffing levels. Results show that the rating on quality measures, an outcome-based measure of quality, is inversely related to costs but unrelated to mean cost efficiency. In other words, a better rating on quality measures is associated with lower nursing home costs. The health inspection rating is not associated with either costs or mean cost efficiency. The rating for staffing levels, a structural measure of quality, is negatively associated with cost efficiency. These findings reveal that different measures of quality have different relationships with costs and cost efficiency. The findings suggest that better quality outcomes in nursing homes may be achievable with fewer resources and/or improved care procedures, which in turn should reduce nursing home costs.

Suggested Citation

  • Rajendra Dulal, 2017. "Cost efficiency of nursing homes: do five-star quality ratings matter?," Health Care Management Science, Springer, vol. 20(3), pages 316-325, September.
    • Handle: RePEc:kap:hcarem:v:20:y:2017:i:3:d:10.1007_s10729-016-9355-5
    DOI: 10.1007/s10729-016-9355-5
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    1. 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.
    2. Mareike Heimeshoff & Jonas Schreyögg & Lukas Kwietniewski, 2014. "Cost and technical efficiency of physician practices: a stochastic frontier approach using panel data," Health Care Management Science, Springer, vol. 17(2), pages 150-161, June.
    3. Annika Herr, 2008. "Cost and technical efficiency of German hospitals: does ownership matter?," Health Economics, John Wiley & Sons, Ltd., vol. 17(9), pages 1057-1071, September.
    4. Luis Murillo-Zamorano & Carmelo Petraglia, 2011. "Technical efficiency in primary health care: does quality matter?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 12(2), pages 115-125, April.
    5. William Greene, 2004. "Distinguishing between heterogeneity and inefficiency: stochastic frontier analysis of the World Health Organization's panel data on national health care systems," Health Economics, John Wiley & Sons, Ltd., vol. 13(10), pages 959-980, October.
    6. Meeusen, Wim & van den Broeck, Julien, 1977. "Efficiency Estimation from Cobb-Douglas Production Functions with Composed Error," International Economic Review, Department of Economics, University of Pennsylvania and Osaka University Institute of Social and Economic Research Association, vol. 18(2), pages 435-444, June.
    7. Grannemann, Thomas W. & Brown, Randall S. & Pauly, Mark V., 1986. "Estimating hospital costs : A multiple-output analysis," Journal of Health Economics, Elsevier, vol. 5(2), pages 107-127, June.
    8. Francesco D'Amico & Jose-Luis Fernandez, 2012. "Measuring Inefficiency in Long-term Care Commissioning: Evidence from English Local Authorities," Applied Economic Perspectives and Policy, Agricultural and Applied Economics Association, vol. 34(2), pages 275-299.
    9. Lindsay G S Bengtson & Anna Kucharska-Newton & Lisa M Wruck & Laura R Loehr & Aaron R Folsom & Lin Y Chen & Wayne D Rosamond & Sue Duval & Pamela L Lutsey & Sally C Stearns & Carla Sueta & Hsin-Chieh , 2014. "Comparable Ascertainment of Newly-Diagnosed Atrial Fibrillation Using Active Cohort Follow-Up versus Surveillance of Centers for Medicare and Medicaid Services in the Atherosclerosis Risk in Communiti," PLOS ONE, Public Library of Science, vol. 9(4), pages 1-8, April.
    10. Newhouse, Joseph P., 1994. "Frontier estimation: How useful a tool for health economics?," Journal of Health Economics, Elsevier, vol. 13(3), pages 317-322, October.
    11. Hung-Jen Wang, 2002. "Heteroscedasticity and Non-Monotonic Efficiency Effects of a Stochastic Frontier Model," Journal of Productivity Analysis, Springer, vol. 18(3), pages 241-253, November.
    12. Shimshak, Daniel G. & Lenard, Melanie L. & Klimberg, Ronald K., 2009. "Incorporating quality into data envelopment analysis of nursing home performance: A case study," Omega, Elsevier, vol. 37(3), pages 672-685, June.
    13. Giulia Garavaglia & Emanuele Lettieri & Tommaso Agasisti & Silvano Lopez, 2011. "Efficiency and quality of care in nursing homes: an Italian case study," Health Care Management Science, Springer, vol. 14(1), pages 22-35, March.
    14. Battese, G E & Coelli, T J, 1995. "A Model for Technical Inefficiency Effects in a Stochastic Frontier Production Function for Panel Data," Empirical Economics, Springer, vol. 20(2), pages 325-332.
    15. Aigner, Dennis & Lovell, C. A. Knox & Schmidt, Peter, 1977. "Formulation and estimation of stochastic frontier production function models," Journal of Econometrics, Elsevier, vol. 6(1), pages 21-37, July.
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    Cited by:

    1. Marouene Chaieb & Jaber Jemai & Khaled Mellouli, 2020. "A decomposition - construction approach for solving the home health care scheduling problem," Health Care Management Science, Springer, vol. 23(2), pages 264-286, June.

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