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Government Regulation and the Quality of Healthcare: Evidence from Minimum Staffing Legislation for Nursing Homes

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  • Jordan D. Matsudaira

Abstract

This paper investigates the effect of a regulation mandating a minimum nurse-staffing level on the quality of healthcare in nursing homes. To comply with the regulation, firms increase employment of nurses in proportion to the gap between their initial staffing level and the legislated minimum threshold. If higher nurse staffing causes better quality, then the changes in quality outcomes should mirror these changes. Despite inducing increases in nurse aide hours of 10 percent on average and up to 30 percent for some firms, I find no impact of the regulation on patient outcomes or overall facility quality.

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  • Jordan D. Matsudaira, 2014. "Government Regulation and the Quality of Healthcare: Evidence from Minimum Staffing Legislation for Nursing Homes," Journal of Human Resources, University of Wisconsin Press, vol. 49(1), pages 32-72.
    • Handle: RePEc:uwp:jhriss:v:49:y:2014:i:1:p:32-72
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    References listed on IDEAS

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    1. Charlene Harrington & David Zimmerman & Sarita L. Karon & James Robinson & Patricia Beutel, 2000. "Nursing Home Staffing and Its Relationship to Deficiencies," The Journals of Gerontology: Series B, The Gerontological Society of America, vol. 55(5), pages 278-287.
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    6. George A. Akerlof, 1970. "The Market for "Lemons": Quality Uncertainty and the Market Mechanism," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 84(3), pages 488-500.
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    Cited by:

    1. John R. Bowblis & Andrew Ghattas, 2017. "The Impact of Minimum Quality Standard Regulations on Nursing Home Staffing, Quality, and Exit Decisions," Review of Industrial Organization, Springer;The Industrial Organization Society, vol. 50(1), pages 43-68, February.
    2. Maibom, Jonas & Sievertsen, Hans H. & Simonsen, Marianne & Wüst, Miriam, 2021. "Maternity ward crowding, procedure use, and child health," Journal of Health Economics, Elsevier, vol. 75(C).
    3. Christopher S. Brunt, 2023. "Assessing the impact of enforcement and compliance with minimum staffing standards on the quality of care in nursing homes: Evidence from the Centers for Medicare and Medicaid Services' staff star rat," Health Economics, John Wiley & Sons, Ltd., vol. 32(2), pages 235-276, February.
    4. Norton, E.C., 2016. "Health and Long-Term Care," Handbook of the Economics of Population Aging, in: Piggott, John & Woodland, Alan (ed.), Handbook of the Economics of Population Aging, edition 1, volume 1, chapter 0, pages 951-989, Elsevier.
    5. Gabriel A. Facchini Palma, 2020. "Low Staffing in the Maternity Ward: Keep Calm and Call the Surgeon," Working Papers wpdea2009, Department of Applied Economics at Universitat Autonoma of Barcelona.
    6. Haizhen Lin, 2014. "Revisiting the relationship between nurse staffing and quality of care in nursing homes: An instrumental variables approach," Working Papers 2014-01, Indiana University, Kelley School of Business, Department of Business Economics and Public Policy.
    7. Lin, Haizhen, 2014. "Revisiting the relationship between nurse staffing and quality of care in nursing homes: An instrumental variables approach," Journal of Health Economics, Elsevier, vol. 37(C), pages 13-24.
    8. John R. Bowblis & Austin C. Smith, 2021. "Occupational Licensing of Social Services and Nursing Home Quality: A Regression Discontinuity Approach," ILR Review, Cornell University, ILR School, vol. 74(1), pages 199-223, January.
    9. Yaa Akosa Antwi & John R. Bowblis, 2018. "The Impact of Nurse Turnover on Quality of Care and Mortality in Nursing Homes: Evidence from the Great Recession," American Journal of Health Economics, University of Chicago Press, vol. 4(2), pages 131-163, Spring.
    10. D. Mark Anderson & Kerwin Kofi Charles & Michael McKelligott & Daniel I. Rees, 2022. "Safeguarding Consumers Through Minimum Quality Standards: Milk Inspections and Urban Mortality, 1880-1910," NBER Working Papers 30063, National Bureau of Economic Research, Inc.
    11. Anderson, D. Mark & Charles, Kerwin Kofi & McKelligott, Michael & Rees, Daniel I., 2022. "Safeguarding Consumers through Minimum Quality Standards: Milk Inspections and Urban Mortality, 1880-1910," IZA Discussion Papers 15295, Institute of Labor Economics (IZA).
    12. Facchini, Gabriel, 2022. "Low staffing in the maternity ward: Keep calm and call the surgeon," Journal of Economic Behavior & Organization, Elsevier, vol. 197(C), pages 370-394.
    13. Min M. Chen & David C. Grabowski, 2015. "Intended and Unintended Consequences of Minimum Staffing Standards for Nursing Homes," Health Economics, John Wiley & Sons, Ltd., vol. 24(7), pages 822-839, July.
    14. Matthew C. Harris & Yinan Liu & Ian McCarthy, 2020. "Capacity constraints and time allocation in public health clinics," Health Economics, John Wiley & Sons, Ltd., vol. 29(3), pages 324-336, March.
    15. Matthew C. Harris & Yinan Liu & Ian McCarthy, 2019. "Capacity Constraints and the Provision of Public Services: The Case of Workers in Public Health Clinics," NBER Working Papers 25706, National Bureau of Economic Research, Inc.

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