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Does the public sector outperform the nonprofit and for-profit sectors? Evidence from a national panel study on nursing home quality and access

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  • Anna A. Amirkhanyan

    (American University)

  • Hyun Joon Kim

    (Texas Tech University)

  • Kristina T. Lambright

    (Binghamton University)

Abstract

Are public and private organizations fundamentally different? This question has been among the most enduring inquiries in public administration. Our study explores the impact of organizational ownership on two complementary aspects of performance: service quality and access to services for impoverished clients. Derived from public management research on performance determinants and nursing home care literature, our hypotheses stipulate that public, nonprofit, and forprofit nursing homes use different approaches to balance the strategic tradeoff between two aspects of performance. Panel data on 14,423 facilities were analyzed to compare measures of quality and access across three sectors using different estimation methods. Findings indicate that ownership status is associated with critical differences in both quality and access. Public and nonprofit organizations are similar in terms of quality, and both perform significantly better than their forprofit counterparts. When compared to nonprofit and, in some cases, for-profit facilities, public nursing homes have a significantly higher share of Medicaid recipients. The paper proposes strategies to address the identified long-term care divide. © 2008 by the Association for Public Policy Analysis and Management.

Suggested Citation

  • Anna A. Amirkhanyan & Hyun Joon Kim & Kristina T. Lambright, 2008. "Does the public sector outperform the nonprofit and for-profit sectors? Evidence from a national panel study on nursing home quality and access," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 27(2), pages 326-353.
    • Handle: RePEc:wly:jpamgt:v:27:y:2008:i:2:p:326-353
    DOI: 10.1002/pam.20327
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    3. Harleman, Max & Weber, Jeremy G., 2023. "Can Collective Action Institutions Outperform the State? Evidence from Treatment of Abandoned Mine Drainage," MPRA Paper 119861, University Library of Munich, Germany.
    4. Ben-Ner Avner & Karaca-Mandic Pinar & Ren Ting, 2012. "Ownership and Quality in Markets with Asymmetric Information: Evidence from Nursing Homes," The B.E. Journal of Economic Analysis & Policy, De Gruyter, vol. 12(1), pages 1-33, October.
    5. Harleman, Max & Weber, Jeremy G., 2023. "Can Collective Action Institutions Outperform the State? Evidence from Treatment of Abandoned Mine Drainage," MPRA Paper 121315, University Library of Munich, Germany.
    6. Bergman, Mats A. & Johansson, Per & Lundberg, Sofia & Spagnolo, Giancarlo, 2016. "Privatization and quality: Evidence from elderly care in Sweden," Journal of Health Economics, Elsevier, vol. 49(C), pages 109-119.
    7. 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.
    8. Xu, Chengxin & Li, Huafang, 2021. "Resource Publicness Matters in Organizational Perceptions," OSF Preprints 7q3v8, Center for Open Science.
    9. Leroy White & Andy Lockett & Graeme Currie & James Hayton, 2021. "Hybrid Context, Management Practices and Organizational Performance: A Configurational Approach," Journal of Management Studies, Wiley Blackwell, vol. 58(3), pages 718-748, May.
    10. Aidan R. Vining, 2016. "What Is Public Agency Strategic Analysis (PASA) and How Does It Differ from Public Policy Analysis and Firm Strategy Analysis?," Administrative Sciences, MDPI, vol. 6(4), pages 1-31, December.
    11. Erik Hembre & Stephanie Moulton & Matthew Record, 2021. "Low‐Income Homeownership and the Role of State Subsidies: A Comparative Analysis of Mortgage Outcomes," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 40(1), pages 78-106, January.
    12. Datta, Anusua & Vandegrift, Donald, 2011. "Effects of welfare reform and the state children’s health insurance program on medicaid and total health expenditures," MPRA Paper 36486, University Library of Munich, Germany.
    13. Jose-Luis Zafra-Gómez & Germán López-Pérez & Marta Garrido-Montañés & Elisabeth Zafra-Gómez, 2023. "Cost Efficiency in Municipal Solid Waste (MSW): Different Alternatives in Service Delivery for Small and Medium Sized Spanish Local Governments," Sustainability, MDPI, vol. 15(7), pages 1-14, April.
    14. Stijn Van Puyvelde & Ralf Caers & Cind Du Bois & Marc Jegers, 2015. "Does organizational ownership matter? Objectives of employees in public, nonprofit and for-profit nursing homes," Applied Economics, Taylor & Francis Journals, vol. 47(24), pages 2500-2513, May.

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