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Xia X, Li Q. Luxury or normal goods? Evidence from the utilization of institutional care services for the disabled older adults in China. Front Public Health 2024; 11:1289502. [PMID: 38249379 PMCID: PMC10796996 DOI: 10.3389/fpubh.2023.1289502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/07/2023] [Indexed: 01/23/2024] Open
Abstract
Background Nursing care is essential for older adults with disabilities. Income plays a crucial role in determining the utilization of institutional care services. Pension benefit, as the main source of income for the older adults in China's cities and towns in their later years, is an important factor influencing the utilization of institutional care services. However, there have been no consistent findings on how pension benefits affect the utilization of institutional care services for the disabled older adults. Methods This paper utilizes data from the 2017-2018 Chinese Longitudinal Healthy Longevity Survey. We select disabled older adults aged 65 and older, living in towns and cities, and use a probit regression model to investigate the impact of pension benefits on the utilization of institutional care services by urban disabled older adults empirically. Results The study shows that a 1% increase in pension benefits raises the probability that the urban disabled older adults use institutional care services by 0.03. It also finds that for low-income urban disabled older adults, the effect is statistically significantly positive at the 1% level; but for high-income urban disabled older adults, the effect is not statistically significant. The pension benefits significantly increase the probability for the disabled older adults who are male, financially dependent, and live in townships. In addition, the pension benefits significantly reduce the probability that children will provide care and pay for care services for their older parents. Conclusion Institutional care service is a normal good for the urban disabled older adults, especially for low-income older adults. Therefore, higher pension benefit raises the probability of utilizing institutional care services for the urban older adults with disabilities, and this positive effect is especially pronounced for older adults who are male, financially dependent, and reside in townships. In addition, increase in the pension benefits for the disabled older adults in towns and cities reduces the burden on children by reducing the probability that children will provide care and pay for care services for the older adults.
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Affiliation(s)
| | - Quanlun Li
- School of Public Administration, Zhongnan University of Economics and Law, Wuhan, Hubei, China
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Werner RM, Konetzka RT, Grabowski DC, Stevenson DG. Reforming Nursing Home Financing, Payment, and Oversight. N Engl J Med 2022; 386:1869-1871. [PMID: 35551508 PMCID: PMC9623821 DOI: 10.1056/nejmp2203429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Rachel M Werner
- From the Leonard Davis Institute of Health Economics and Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.M.W.); the Department of Public Health Sciences, University of Chicago, Chicago (R.T.K.); the Department of Health Care Policy, Harvard Medical School, Boston (D.C.G.); and the Department of Health Policy, Vanderbilt University School of Medicine, Nashville (D.G.S.)
| | - R Tamara Konetzka
- From the Leonard Davis Institute of Health Economics and Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.M.W.); the Department of Public Health Sciences, University of Chicago, Chicago (R.T.K.); the Department of Health Care Policy, Harvard Medical School, Boston (D.C.G.); and the Department of Health Policy, Vanderbilt University School of Medicine, Nashville (D.G.S.)
| | - David C Grabowski
- From the Leonard Davis Institute of Health Economics and Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.M.W.); the Department of Public Health Sciences, University of Chicago, Chicago (R.T.K.); the Department of Health Care Policy, Harvard Medical School, Boston (D.C.G.); and the Department of Health Policy, Vanderbilt University School of Medicine, Nashville (D.G.S.)
| | - David G Stevenson
- From the Leonard Davis Institute of Health Economics and Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.M.W.); the Department of Public Health Sciences, University of Chicago, Chicago (R.T.K.); the Department of Health Care Policy, Harvard Medical School, Boston (D.C.G.); and the Department of Health Policy, Vanderbilt University School of Medicine, Nashville (D.G.S.)
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Garrett B, Carter C, Wissoker D. Evaluation of the Reliability of Medicare Spending Per Beneficiary for Post-Acute Care. Med Care 2021; 59:721-726. [PMID: 33935252 DOI: 10.1097/mlr.0000000000001560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND A measure of episode spending, such as Medicare Spending Per Beneficiary (MSPB) is increasingly used to evaluate provider performance. Yet if the measure is unreliable, as is often true for low-volume providers, it cannot distinguish "good" from "poor" performance. OBJECTIVE The objective of this study was to evaluate the reliability of a uniformly calculated MSPB measure for post-acute care (PAC) and the tradeoffs involved in setting a minimum case count threshold. DATA Medicare claims for 15 million PAC episodes from April 2013 to March 2015. RESEARCH DESIGN Given the overlap in patients treated in PAC settings, we developed a uniformly calculated MSPB measure for PAC providers that measures spending during the PAC stay and the following 30 days. We examine variation in the MSPB-PAC measure and characterize the measure's reliability and its relationship to provider case counts. RESULTS Applied to our MSPB-PAC measure, a minimum threshold of 20 Medicare episodes as currently used by the Centers for Medicare & Medicaid Services (CMS) would not establish reasonably reliable measures and could result in drawing unduly erroneous conclusions about provider performance. The measures for home health agencies were considerably less stable and reliable than for institutional PAC providers. CONCLUSIONS CMS should consider adopting a more stringent reliability standard for setting minimum case counts for MSPB-PAC and other measures. Its current threshold (R-statistic=0.4) reflects more random variation than differences in actual provider performance. To include as many providers as possible, CMS should consider pooling data over multiple years to avoid drawing incorrect conclusions about low-volume providers.
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Affiliation(s)
| | | | - Doug Wissoker
- Urban Institute, Statistical Methods Group, Washington, DC
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Affiliation(s)
- Jill Manthorpe
- NIHR Health and Social Care Workforce Research Unit, Policy Institute, King's College London, London, UK
| | - Steve Iliffe
- University College London, Royal Free Campus, London, UK
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Kruse FM, Ligtenberg WMR, Oerlemans AJM, Groenewoud S, Jeurissen PPT. How the logics of the market, bureaucracy, professionalism and care are reconciled in practice: an empirical ethics approach. BMC Health Serv Res 2020; 20:1024. [PMID: 33168083 PMCID: PMC7654039 DOI: 10.1186/s12913-020-05870-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 10/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the Netherlands, the for-profit sector has gained a substantial share of nursing home care within just a few years. The ethical question that arises from the growth of for-profit care is whether the market logic can be reconciled with the provision of healthcare. This question relates to the debate on the Moral Limits of Markets (MLM) and commodification of care. METHODS The contribution of this study is twofold. Firstly, we construct a theoretical framework from existing literature; this theoretical framework differentiates four logics: the market, bureaucracy, professionalism, and care. Secondly, we follow an empirical ethics approach; we used three for-profit nursing homes as case studies and conducted qualitative interviews with various stakeholders. RESULTS Four main insights emerge from our empirical study. Firstly, there are many aspects of the care relationship (e.g. care environment, personal relationships, management) and every aspect of the relationship should be considered because the four logics are reconciled differently for each aspect. The environment and conditions of for-profit nursing homes are especially commodified. Secondly, for-profit nursing homes pursue a different professional logic from the traditional, non-profit sector - one which is inspired by the logic of care and which contrasts with bureaucratic logic. However, insofar as professionals in for-profit homes are primarily responsive to residents' wishes, the market logic also prevails. Thirdly, a multilevel approach is necessary to study the MLM in the care sector since the degree of commodification differs by level. Lastly, it is difficult for the market to engineer social cohesion among the residents of nursing homes. CONCLUSIONS The for-profit nursing home sector does embrace the logic of the market but reconciles it with other logics (i.e. logic of care and logic of professionalism). Importantly, for-profit nursing homes have created an environment in which care professionals can provide person-oriented care, thereby reconciling the logic of the market with the logic of care.
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Affiliation(s)
- Florien M Kruse
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands.
| | - Wieke M R Ligtenberg
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands
| | - Anke J M Oerlemans
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands
| | - Stef Groenewoud
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands
| | - Patrick P T Jeurissen
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands
- Ministry of Health, Welfare and Sport, The Hague, The Netherlands
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Ankuda CK, Moreno J, McKendrick K, Aldridge MD. Trends in Older Adults' Knowledge of Medicare Advantage Benefits, 2010 to 2016. J Am Geriatr Soc 2020; 68:2343-2347. [PMID: 32562568 PMCID: PMC8049536 DOI: 10.1111/jgs.16656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/17/2020] [Accepted: 05/19/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND/OBJECTIVES The Medicare Advantage (MA) program insures a rapidly growing proportion of older adults, and may be more appealing due to lower cost sharing. However, the extent to which older adults are informed of their plan benefits and how plan knowledge has changed over time is unclear. We evaluated temporal trends and characteristics associated with not knowing MA coverage for dental, vision, and nursing home (NH) services. DESIGN Longitudinal cohort study. SETTING Medicare Current Beneficiary Survey (MCBS), 2010 to 2016. PARTICIPANTS Adults aged 65 years or older enrolled in MA plans and not in Medicaid. MEASUREMENTS Insurance knowledge was determined from separate items asking if individuals had coverage through their MA plan for dental, vision, and NH care. Responses were dichotomized between responding yes/no and not knowing. Demographic, clinical, and functional characteristics were assessed from the MCBS. RESULTS The proportion of older adults in MA who did not know if their plan covered NH care increased from 38.0% in 2010 to 45.5% in 2016. However, proportions of not knowing dental benefits decreased from 6.4% in 2010 to 3.4% in 2016 and not knowing vision benefits decreased from 8.2% in 2010 to 5.9% in 2016. We found significant associations of race, education, income, region, and disability with knowledge of MA benefits. CONCLUSIONS As enrollment in MA plans has grown, older adults in MA plans increasingly report that they know their plan's vision and dental benefits, although they decreasingly know about NH care. Older adults from racial and ethnic minority groups, with lower levels of education and income and who reside in certain regions or have functional disability, are less likely to know their plan benefits. This may imply decreasing preparedness for future long-term care needs. J Am Geriatr Soc 68:2343-2347, 2020.
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Affiliation(s)
- Claire K Ankuda
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jaison Moreno
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Karen McKendrick
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Melissa D Aldridge
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
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Wichmann AB, Adang EMM, Vissers KCP, Szczerbińska K, Kylänen M, Payne S, Gambassi G, Onwuteaka-Philipsen BD, Smets T, Van den Block L, Deliens L, Vernooij-Dassen MJFJ, Engels Y. Decreased costs and retained QoL due to the 'PACE Steps to Success' intervention in LTCFs: cost-effectiveness analysis of a randomized controlled trial. BMC Med 2020; 18:258. [PMID: 32957971 PMCID: PMC7507669 DOI: 10.1186/s12916-020-01720-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 07/24/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The number of residents in long-term care facilities (LTCFs) in need of palliative care is growing in the Western world. Therefore, it is foreseen that significantly higher percentages of budgets will be spent on palliative care. However, cost-effectiveness analyses of palliative care interventions in these settings are lacking. Therefore, the objective of this paper was to assess the cost-effectiveness of the 'PACE Steps to Success' intervention. PACE (Palliative Care for Older People) is a 1-year palliative care programme aiming at integrating general palliative care into day-to-day routines in LTCFs, throughout seven EU countries. METHODS A cluster RCT was conducted. LTCFs were randomly assigned to intervention or usual care. LTCFs reported deaths of residents, about whom questionnaires were filled in retrospectively about resource use and quality of the last month of life. A health care perspective was adopted. Direct medical costs, QALYs based on the EQ-5D-5L and costs per quality increase measured with the QOD-LTC were outcome measures. RESULTS Although outcomes on the EQ-5D-5L remained the same, a significant increase on the QOD-LTC (3.19 points, p value 0.00) and significant cost-savings were achieved in the intervention group (€983.28, p value 0.020). The cost reduction mainly resulted from decreased hospitalization-related costs (€919.51, p value 0.018). CONCLUSIONS Costs decreased and QoL was retained due to the PACE Steps to Success intervention. Significant cost savings and improvement in quality of end of life (care) as measured with the QOD-LTC were achieved. A clinically relevant difference of almost 3 nights shorter hospitalizations in favour of the intervention group was found. This indicates that timely palliative care in the LTCF setting can prevent lengthy hospitalizations while retaining QoL. In line with earlier findings, we conclude that integrating general palliative care into daily routine in LTCFs can be cost-effective. TRIAL REGISTRATION ISRCTN14741671 .
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Affiliation(s)
- Anne B Wichmann
- IQ Health Care, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands.
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Eddy M M Adang
- Department for Health Evidencef, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Kris C P Vissers
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Katarzyna Szczerbińska
- Unit for Research on Aging Society, Epidemiology and Preventive Medicine Chair, Jagiellonian University Medical College, Kraków, Poland
| | - Marika Kylänen
- National Institute for Health and Welfare, Helsinki, Finland
| | - Sheila Payne
- Division of Health Research, Lancaster University, Lancaster, England
| | - Giovanni Gambassi
- Faculty of Medicine and Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Tinne Smets
- End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussel, Belgium
| | - Lieve Van den Block
- End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussel, Belgium
| | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussel, Belgium
| | - Myrra J F J Vernooij-Dassen
- IQ Health Care, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Yvonne Engels
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
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Abstract
BACKGROUND Although one third of Medicare beneficiaries are enrolled in Medicare Advantage (MA) plans, there is limited information about the cost of treating Alzheimer disease and related dementias (ADRD) in these settings. OBJECTIVE The objective of this study was to estimate direct health care costs attributable to ADRD among older adults within a large MA plan. RESEARCH DESIGN A retrospective cohort design was used to estimate direct total, outpatient, inpatient, ambulatory pharmacy, and nursing home costs for 3 years before and after an incident ADRD diagnosis for 927 individuals diagnosed with ADRD relative to a sex-matched and birth year-matched set of 2945 controls. SUBJECT Adults 65 years of age and older enrolled in the Kaiser Permanente Washington MA plan and the Adult Changes in Thought (ACT) Study, a prospective longitudinal cohort study of ADRD and brain aging. MEASURES Data on monthly health service use obtained from health system electronic medical records for the period 1992-2012. RESULTS Total monthly health care costs for individuals with ADRD are statistically greater (P<0.05) than controls beginning in the third month before diagnosis and remain significantly greater through the eighth month following diagnosis. Greater total health costs are driven by significantly (P<0.05) greater nursing home costs among individuals diagnosed with ADRD beginning in the third month prediagnosis. Although total costs were no longer significantly greater at 8 months following diagnosis, nursing home costs remained higher for the people with dementia through the 3 years postdiagnosis we analyzed. CONCLUSION Greater total health care costs among individuals with ADRD are primarily driven by nursing home costs.
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Affiliation(s)
| | - Lindsay White
- Department of Health Services, University of Washington
- RTI International, Seattle, WA
| | | | - Sungchul Park
- Department of Health Management and Policy, Drexel University, Philadelphia, PA
| | - Eric B Larson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | - Paul Crane
- Department of Health Services, University of Washington
| | - Norma B Coe
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA
- The National Bureau of Economic Research (NBER), Cambridge, MA
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Righi L, Ourahmoune A, Béné N, Rae AC, Courvoisier DS, Chopard P. Effects of a pressure-ulcer audit and feedback regional programme at 1 and 2 years in nursing homes: A prospective longitudinal study. PLoS One 2020; 15:e0233471. [PMID: 32469916 PMCID: PMC7259581 DOI: 10.1371/journal.pone.0233471] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 05/05/2020] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Pressure ulcer is a frequent complication in patients hospitalized in nursing homes and has a serious impact on quality of life and overall health. Moreover, ulcer treatment is highly expensive. Several studies have shown that pressure ulcer prevention is cost-effective. Audit and feedback programmes can help improve professional practices in pressure ulcer prevention and thus reduce their occurrence. The aim of this study was to analyze, with a prospective longitudinal study, the effectiveness of an audit and feedback programme at 1- and 2-year follow-up for reducing pressure ulcer prevalence and enhancing adherence to preventive practices in nursing homes. METHODS Pressure ulcer point prevalence and preventive practices were measured in 2015, 2016 and 2017 in nursing homes of the Canton of Geneva (Switzerland). Oral and written feedback was provided 2 months after every survey to nursing home reference nurses. RESULTS A total of 27 nursing homes participated in the programme in 2015 and 2016 (4607 patients) and 15 continued in 2017 (1357 patients). Patients were mostly females, with mean age > 86 years and median length of stay about 2 years. The programme significantly improved two preventive measures: patient repositioning and anti-decubitus bed or mattress. It also reduced acquired pressure ulcers prevalence in nursing homes that participated during all 3 years (from 4.5% in 2015 to 2.9% in 2017, p 0.035), especially in those with more patients with pressure ulcers. CONCLUSION Audit and feedback is relatively easy to implement at the regional level in nursing homes and can enhance adherence to preventive measures and reduce pressure ulcers prevalence in the homes.
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Affiliation(s)
- Lorenzo Righi
- Quality of Care Unit, University Hospitals of Geneva, Geneva, Switzerland
- Department of General Internal Medicine, Rehabilitation and Geriatrics, University of Geneva, Geneva, Switzerland
- Quality of Care and Clinical Networks, Tuscany Region, Italy
| | - Aimad Ourahmoune
- Quality of Care Unit, University Hospitals of Geneva, Geneva, Switzerland
- Department of General Internal Medicine, Rehabilitation and Geriatrics, University of Geneva, Geneva, Switzerland
| | - Nadine Béné
- Geneva Nursing Homes Association, Geneva, Switzerland
| | - Anne-Claire Rae
- Health Care Research and Quality, University Hospitals of Geneva, Geneva, Switzerland
| | - Delphine S. Courvoisier
- Quality of Care Unit, University Hospitals of Geneva, Geneva, Switzerland
- Department of General Internal Medicine, Rehabilitation and Geriatrics, University of Geneva, Geneva, Switzerland
| | - Pierre Chopard
- Quality of Care Unit, University Hospitals of Geneva, Geneva, Switzerland
- Department of General Internal Medicine, Rehabilitation and Geriatrics, University of Geneva, Geneva, Switzerland
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Abstract
OBJECTIVE This study aimed to estimate global inpatient, outpatient, prescribing and care home costs for patients with atrial fibrillation using population-based, individual-level linked data. DESIGN A two-part model was employed to estimate the probability of resource utilisation and costs conditional on positive utilisation using individual-level linked data. SETTINGS Scotland, 5 years following first hospitalisation for AF between 1997 and 2015. PARTICIPANTS Patients hospitalised with a known diagnosis of AF or atrial flutter. PRIMARY AND SECONDARY OUTCOME MEASURES Inpatient, outpatient, prescribing and care home costs. RESULTS The mean annual cost for a patient with AF was estimated at £3785 (95% CI £3767 to £3804). Inpatient admissions and outpatient visits accounted for 79% and 8% of total costs, respectively; prescriptions and care home stay accounted for 7% and 6% of total costs. Inpatient cost was the main driver across all age groups. While inpatient cost contributions (~80%) were constant between 0 and 84 years, they decreased for patients over 85 years. This is offset by increasing care home cost contributions. Mean annual costs associated with AF increased significantly with increasing number of comorbidities. CONCLUSION This study used a contemporary and representative cohort, and a comprehensive approach to estimate global costs associated with AF, taking into account resource utilisation beyond hospital care. While overall costs, considerably affected by comorbidity, did not increase with increasing age, care home costs increased proportionally with age. Inpatient admission was the main contributor to the overall financial burden of AF, highlighting the need for improved mechanisms of early diagnosis to prevent hospitalisations.
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Affiliation(s)
- Giorgio Ciminata
- Health Economics and Health Technology Assessment (HEHTA), University of Glasgow, Glasgow, UK
| | - Claudia Geue
- Health Economics and Health Technology Assessment (HEHTA), University of Glasgow, Glasgow, UK
| | - Peter Langhorne
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Olivia Wu
- Health Economics and Health Technology Assessment (HEHTA), University of Glasgow, Glasgow, UK
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Booth J, Aucott L, Cotton S, Goodman C, Hagen S, Harari D, Lawrence M, Lowndes A, Macaulay L, MacLennan G, Mason H, McClurg D, Norrie J, Norton C, O’Dolan C, Skelton DA, Surr C, Treweek S. ELECtric Tibial nerve stimulation to Reduce Incontinence in Care homes: protocol for the ELECTRIC randomised trial. Trials 2019; 20:723. [PMID: 31843002 PMCID: PMC6915984 DOI: 10.1186/s13063-019-3723-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 09/13/2019] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Urinary incontinence (UI) is highly prevalent in nursing and residential care homes (CHs) and profoundly impacts on residents' dignity and quality of life. CHs predominantly use absorbent pads to contain UI rather than actively treat the condition. Transcutaneous posterior tibial nerve stimulation (TPTNS) is a non-invasive, safe and low-cost intervention with demonstrated effectiveness for reducing UI in adults. However, the effectiveness of TPTNS to treat UI in older adults living in CHs is not known. The ELECTRIC trial aims to establish if a programme of TPTNS is a clinically effective treatment for UI in CH residents and investigate the associated costs and consequences. METHODS This is a pragmatic, multicentre, placebo-controlled, randomised parallel-group trial comparing the effectiveness of TPTNS (target n = 250) with sham stimulation (target n = 250) in reducing volume of UI in CH residents. CH residents (men and women) with self- or staff-reported UI of more than once per week are eligible to take part, including those with cognitive impairment. Outcomes will be measured at 6, 12 and 18 weeks post randomisation using the following measures: 24-h Pad Weight Tests, post void residual urine (bladder scans), Patient Perception of Bladder Condition, Minnesota Toileting Skills Questionnaire and Dementia Quality of Life. Economic evaluation based on a bespoke Resource Use Questionnaire will assess the costs of providing a programme of TPTNS. A concurrent process evaluation will investigate fidelity to the intervention and influencing factors, and qualitative interviews will explore the experiences of TPTNS from the perspective of CH residents, family members, CH staff and managers. DISCUSSION TPTNS is a non-invasive intervention that has demonstrated effectiveness in reducing UI in adults. The ELECTRIC trial will involve CH staff delivering TPTNS to residents and establish whether TPTNS is more effective than sham stimulation for reducing the volume of UI in CH residents. Should TPTNS be shown to be an effective and acceptable treatment for UI in older adults in CHs, it will provide a safe, low-cost and dignified alternative to the current standard approach of containment and medication. TRIAL REGISTRATION ClinicalTrials.gov, NCT03248362. Registered on 14 August 2017. ISRCTN, ISRCTN98415244. Registered on 25 April 2018. https://www.isrctn.com/.
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Affiliation(s)
- J. Booth
- School of Health and Life Sciences, Glasgow Caledonian University, Govan Mbeki Building, Glasgow, G4 0BA UK
| | - L. Aucott
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
| | - S. Cotton
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
| | - C. Goodman
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - S. Hagen
- Nursing, Midwifery and Allied Health Professions Research Unit (NMAHP RU), Glasgow Caledonian University, Glasgow, UK
| | - D. Harari
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - M. Lawrence
- School of Health and Life Sciences, Glasgow Caledonian University, Govan Mbeki Building, Glasgow, G4 0BA UK
| | - A. Lowndes
- Playlist for Life, Unit 1/14, Govanhill Workspace, Glasgow,, UK
| | - L. Macaulay
- School of Health and Life Sciences, Glasgow Caledonian University, Govan Mbeki Building, Glasgow, G4 0BA UK
| | - G. MacLennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - H. Mason
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - D. McClurg
- Nursing, Midwifery and Allied Health Professions Research Unit (NMAHP RU), Glasgow Caledonian University, Glasgow, UK
| | - J. Norrie
- Usher Institute, Edinburgh University, Edinburgh, UK
| | | | - C. O’Dolan
- School of Health and Life Sciences, Glasgow Caledonian University, Govan Mbeki Building, Glasgow, G4 0BA UK
| | - D. A. Skelton
- School of Health and Life Sciences, Glasgow Caledonian University, Govan Mbeki Building, Glasgow, G4 0BA UK
| | - C. Surr
- School of Health and Community Studies, Leeds Beckett University, Leeds, UK
| | - S. Treweek
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
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Abstract
Dramatic improvements in reported nursing home quality, including staffing ratios, have come under increased scrutiny in recent years because they are based on data self-reported by nursing homes. In contrast to other domains, the key mechanism for real improvement in the staffing ratios domain is clearer: to improve scores, nursing homes should increase staffing expenditures. We analyze the relationship between changes in expenditures and reported staffing quality pre- versus post the 5-star rating system. Our results show that the relationship between expenditures and licensed practical nurse staffing is weaker in the post-5-star period, overall, and across subgroups; furthermore, there is a weaker relationship between expenditures and registered nurse staffing among for-profit facilities with a high share of Medicaid residents in the post-5-star period. The weaker relationship between staffing expenditures and staffing scores in the post-5-star era underscores the potential for gaming of the self-reported staffing scores and the need for more reliable sources.
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Kümpel C. Do financial incentives influence the hospitalization rate of nursing home residents? Evidence from Germany. Health Econ 2019; 28:1235-1247. [PMID: 31523874 DOI: 10.1002/hec.3930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 06/10/2019] [Accepted: 06/17/2019] [Indexed: 06/10/2023]
Abstract
Efficient health-care provision for nursing home residents is a concern in many OECD (Organization for Economic Cooperation and Development) countries. This paper analyzes whether nursing homes respond to financial incentives when deciding whether to hospitalize their residents. In Germany, reimbursements for nursing homes are reduced after a defined number of days when a resident stays in a hospital instead of a nursing home. As a result of a federal law introduced in 2008, some German states had to change the point at which reimbursements to nursing homes are reduced so that reductions are made from Day 4 instead of Day 1 of a resident's absence. This exogenously raised an incentive for the nursing homes affected to hospitalize residents especially for an expected short-term stay. This analysis exploits the introduction of the law in a difference-in-difference approach, using market-wide German-DRG files covering all hospital patients discharged from hospitals to nursing homes from 2007 to 2011. The results suggest an increase of approximately 11% in short-term hospital stays as a consequence of the longer reimbursement period introduced by the law.
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Affiliation(s)
- Christian Kümpel
- Hamburg Center for Health Economics, Universität Hamburg, Hamburg, Germany
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Kurowski A, Pransky G, Punnett L. Impact of a Safe Resident Handling Program in Nursing Homes on Return-to-Work and Re-injury Outcomes Following Work Injury. J Occup Rehabil 2019; 29:286-294. [PMID: 29785467 PMCID: PMC6422723 DOI: 10.1007/s10926-018-9785-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Purpose This study examined the impact of a Safe Resident Handling Program (SRHP) on length of disability and re-injury, following work-related injuries of nursing home workers. Resident handling-related injuries and back injuries were of particular interest. Methods A large national nursing home corporation introduced a SRHP followed by three years of training for 136 centers. Lost-time workers' compensation claims (3 years pre-SRHP and 6 years post-SRHP) were evaluated. For each claim, length of first episode of disability and recurrence of disabling injury were evaluated over time. Differences were assessed using Chi square analyses and a generalized linear model, and "avoided" costs were projected. Results The SRHP had no impact on length of disability, but did appear to significantly reduce the rate of recurrence among resident handling-related injuries. As indemnity and medical costs were three times higher for claimants with recurrent disabling injuries, the SRHP resulted in significant "avoided" costs due to "avoided" recurrence. Conclusions In addition to reducing overall injury rates, SRHPs appear to improve long-term return-to-work success by reducing the rate of recurrent disabling injuries resulting in work disability. In this study, the impact was sustained over years, even after a formal training and implementation program ended. Since back pain is inherently a recurrent condition, results suggest that SRHPs help workers remain at work and return-to-work.
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Affiliation(s)
- Alicia Kurowski
- Department of Biomedical Engineering, University of Massachusetts Lowell, 1 University Ave., Lowell, MA, 01854, USA.
| | - Glenn Pransky
- Department of Biomedical Engineering, University of Massachusetts Lowell, 1 University Ave., Lowell, MA, 01854, USA
- Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, MA, 01655, USA
| | - Laura Punnett
- Department of Biomedical Engineering, University of Massachusetts Lowell, 1 University Ave., Lowell, MA, 01854, USA
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Abstract
The objective of the current study was to investigate the perspectives of nursing home (NH) providers regarding the requirements to achieve reimbursement for nursing restorative care (NRC) services and propose recommendations to state agencies to assist NH providers to conduct NRC programs that are person-centered and able to achieve full reimbursement. Methods included a survey of NH providers in one state and a stakeholder focus group to discuss survey findings and develop recommendations. Key findings are that NH providers perceive value to residents from the provision of NRC; providers do not associate these benefits with the stringent reimbursement requirements; and NHs often provide NRC that is individualized, based on resident goals and activity tolerance, as well as realistic given competing demands on staff, even when doing so means giving up reimbursement for NRC services. Recommendations include basing reimbursement for NRC on outcomes rather than the process; reconsideration of the frequency and intensity requirements for NRC components; and increased availability of NRC training/education and resources for providers and case-mix reviewers. [Journal of Gerontological Nursing, 45(5), 5-10.].
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Akdeniz M, Hahnel E, Ulrich C, Blume-Peytavi U, Kottner J. Prevalence and associated factors of skin cancer in aged nursing home residents: A multicenter prevalence study. PLoS One 2019; 14:e0215379. [PMID: 31009466 PMCID: PMC6476496 DOI: 10.1371/journal.pone.0215379] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 04/01/2019] [Indexed: 11/18/2022] Open
Abstract
Non-melanoma-skin cancer is an emerging clinical problem in the elderly, fair skinned population which predominantly affects patients aged older than 70 years. Its steady increase in incidence rates and morbidity is paralleled by related medical costs. Despite the fact that many elderly patients are in need of care and are living in nursing homes, specific data on the prevalence of skin cancer in home care and the institutional long-term care setting is currently lacking. A representative multicenter prevalence study was conducted in a random sample of ten institutional long-term care facilities in the federal state of Berlin, Germany. In total, n = 223 residents were included. Actinic keratoses, the precursor lesions of invasive cutaneous squamous cell carcinoma were the most common epithelial skin lesions (21.1%, 95% CI 16.2 to 26.9). Non-melanoma skin cancer was diagnosed in 16 residents (7.2%, 95% CI 4.5 to 11.3). None of the residents had a malignant melanoma. Only few bivariate associations were detected between non-melanoma skin cancer and demographic, biographic and functional characteristics. Male sex was significantly associated with actinic keratosis whereas female sex was associated with non-melanoma skin cancer. Smoking was associated with an increased occurrence of non-melanoma skin cancer. Regular dermatology check-ups in nursing homes would be needed but already now due to financial limitations, lack of time in daily clinical practice and limited number of practising dermatologists, it is not the current standard. With respect to the worldwide growing aging population new programs and decisions are required. Overall, primary health care professionals should play a more active role in early diagnosis of skin cancer in nursing home residents. Dermoscopy courses, web-based or smartphone-based applications and teledermatology may support health care professionals to provide elderly nursing home residents an early diagnosis of skin cancer.
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Affiliation(s)
- Merve Akdeniz
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité-Universitätsmedizin Berlin, Germany
| | - Elisabeth Hahnel
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité-Universitätsmedizin Berlin, Germany
| | - Claas Ulrich
- Department of Dermatology and Allergy, Skin Cancer Center, Charité-Universitätsmedizin, Berlin, Germany
| | - Ulrike Blume-Peytavi
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité-Universitätsmedizin Berlin, Germany
| | - Jan Kottner
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité-Universitätsmedizin Berlin, Germany
- * E-mail:
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Eckermann S, Phillipson L, Fleming R. Re-design of Aged Care Environments is Key to Improved Care Quality and Cost Effective Reform of Aged and Health System Care. Appl Health Econ Health Policy 2019; 17:127-130. [PMID: 30328015 DOI: 10.1007/s40258-018-0435-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Simon Eckermann
- Australian Health Services Research Institute, University of Wollongong, Wollongong, Australia.
| | - Lyn Phillipson
- School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, Australia
| | - Richard Fleming
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
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Affiliation(s)
- Lynn A Flint
- From the Division of Geriatrics, Department of Medicine (D.J.D., A.K.S.), and School of Nursing, Department of Community Health Systems (D.J.D), University of California, San Francisco, and the San Francisco Veterans Affairs Medical Center (D.J.D., A.K.S.) - both in San Francisco
| | - Daniel J David
- From the Division of Geriatrics, Department of Medicine (D.J.D., A.K.S.), and School of Nursing, Department of Community Health Systems (D.J.D), University of California, San Francisco, and the San Francisco Veterans Affairs Medical Center (D.J.D., A.K.S.) - both in San Francisco
| | - Alexander K Smith
- From the Division of Geriatrics, Department of Medicine (D.J.D., A.K.S.), and School of Nursing, Department of Community Health Systems (D.J.D), University of California, San Francisco, and the San Francisco Veterans Affairs Medical Center (D.J.D., A.K.S.) - both in San Francisco
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Weech-Maldonado R. Foreword to "Nursing Home Performance: Organizational and Environmental Factors". Inquiry 2019; 56:46958019850732. [PMID: 31104573 PMCID: PMC6537291 DOI: 10.1177/0046958019850732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 04/23/2019] [Indexed: 06/09/2023]
Abstract
This special collection explores the organizational and environmental factors influencing nursing home performance. The papers in this special collection fall into 3 broad themes. The first theme addresses issues related to nursing home quality measures and public reporting. The second group of papers examines how organizational resources and the environment may influence nursing home performance. The third group of papers examines the relationships among management, strategy, and performance. Findings from this special collection can inform managers and policy makers on best practices and policies that can enhance organizational performance and ultimately ensure access to long-term care.
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Weech-Maldonado R, Lord J, Pradhan R, Davlyatov G, Dayama N, Gupta S, Hearld L. High Medicaid Nursing Homes: Organizational and Market Factors Associated With Financial Performance. Inquiry 2019; 56:46958018825061. [PMID: 30739512 PMCID: PMC6376504 DOI: 10.1177/0046958018825061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 11/29/2018] [Accepted: 12/14/2018] [Indexed: 11/17/2022]
Abstract
High Medicaid nursing homes (85% and higher of Medicaid residents) operate in resource-constrained environments. High Medicaid nursing homes (on average) have lower quality and poorer financial performance. However, there is significant variation in performance among high Medicaid nursing homes. The purpose of this study is to examine the organizational and market factors that may be associated with better financial performance among high Medicaid nursing homes. Data sources included Long-Term Care Focus (LTCFocus), Centers for Medicare and Medicaid Services' (CMS) Medicare Cost Reports, CMS Nursing Home Compare, and the Area Health Resource File (AHRF) for 2009-2015. There were approximately 1108 facilities with high Medicaid per year. The dependent variables are nursing homes operating and total margin. The independent variables included size, chain affiliation, occupancy rate, percent Medicare, market competition, and county socioeconomic status. Control variables included staffing variables, resident quality, for-profit status, acuity index, percent minorities in the facility, percent Medicaid residents, metropolitan area, and Medicare Advantage penetration. Data were analyzed using generalized estimating equations with state and year fixed effects. Results suggest that organizational and market slack resources are associated with performance differentials among high Medicaid nursing homes. Higher financial performing facilities are characterized as having nurse practitioners/physician assistants, more beds, higher occupancy rate, higher Medicare and Medicaid census, and being for-profit and located in less competitive markets. Higher levels of Registered Nurse (RN) skill mix result in lower financial performance in high Medicaid nursing homes. Policy and managerial implications of the study are discussed.
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Affiliation(s)
| | | | - Rohit Pradhan
- University of Arkansas for Medical Sciences, Little Rock, USA
| | | | - Neeraj Dayama
- University of Arkansas for Medical Sciences, Little Rock, USA
| | - Shivani Gupta
- The University of Southern Mississippi, Hattiesburg, USA
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Fleming JA, Brude SB. Medicaid Provider Tax. Issue Brief Health Policy Track Serv 2018; 2018:1-22. [PMID: 30681815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Broulikova HM, Sladek V, Arltova M, Cerny J. The Potential Impact of Alzheimer's Disease Early Treatment on Societal Costs of Care in Czechia: A Simulation Approach. J Ment Health Policy Econ 2018; 21:147-161. [PMID: 30676992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 10/05/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND In Czechia, only about a quarter of people suffering from the Alzheimer's disease (AD) receive (usually belated) treatment. Because of their more rapid cognitive decline, untreated patients require extensive assistance with basic daily activities earlier than those receiving treatment. This assistance provided at home and nursing homes represents a substantial economic burden. AIMS OF THE STUDY To calculate lifetime costs of care per AD patient and to evaluate potential care savings from early treatment. METHODS We use Monte Carlo simulation to model lifetime societal costs of care per patient under two different scenarios. In the first one, a cohort of 100,000 homogeneous patients receives usual care under which the majority of patients are undiagnosed or diagnosed late. The second scenario models a hypothetical situation in which an identical cohort of patients starts receiving treatment early after the disease onset. Data on the rates of cognitive decline for treated and untreated patients, and survival probability for AD patients are derived from foreign clinical studies. Information on costs and population characteristics is compiled on the basis of published Czech research and databases. RESULTS Early treatment of AD decreases social lifetime costs of care. This result holds true regardless of gender, age at which the disease is contracted, or whether the patient lives at home or uses a social residential service. The potential savings amount up to Euro 26,800 (23,500) per woman (man), being negatively correlated with the age at which the disease onsets as well as the delay between the onset and treatment initiation DISCUSSION: The results suggest that early treatment of AD would decrease costs of care in Czechia. The main limitation of the simulation arises from the fact that missing domestic information was substituted by input from foreign clinical trials or simplifying assumptions. Because of insufficient data, we do not model hospitalization risk; on the other hand, introduction of this risk into our model would likely increase the savings from early treatment. IMPLICATIONS FOR HEALTH POLICIES Makers of AD policies ought to appreciate the trade-off between costs of daily assistance in untreated patients and health care costs in treated patients, notwithstanding that the costs of assistance are largely born by households rather than public budgets. Our results show that the savings on costs of assistance brought about by early treatment would exceed the additional costs of treatment. IMPLICATIONS FOR FURTHER RESEARCH A number of missing or insufficient data about the Czech Alzheimer's population were identified. In addition, to determine the total societal cost-effect of early treatment, further research ought to evaluate the related increase in detection costs. Finally, it should also assess cost-effectiveness of early treatment by considering its impact on patients' utility.
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Affiliation(s)
- Hana M Broulikova
- University of Economics, Prague. Department of Statistics and Probability, University of Economics; W. Churchill Sq. 1938/4, 130 67 Prague, Czech Republic,
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Department of Veterans Affairs. Per Diem Paid to States for Care of Eligible Veterans in State Homes. Final rule. Fed Regist 2018; 83:61250-86. [PMID: 30497125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This rulemaking adopts as final, with changes, proposed amendments to VA's regulations governing payment of per diem to States for nursing home care, domiciliary care, and adult day health care for eligible veterans in State homes. This rulemaking reorganizes, updates, and clarifies State home regulations, authorizes greater flexibility in adult day health care programs, and establishes regulations regarding domiciliary care, with clarifications regarding the care that State homes must provide to veterans in domiciliaries.
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Abstract
The paper outlines the policy context and summarizes the numerous policy issues that AD raises from the more generic to the unique. It posits that strong public fears of AD and its future prevalence projections and costs, raise increasingly difficult policy dilemmas. After reviewing the costs in human lives and money and discussing the latest U.S. policy initiatives, the paper presents two policy areas as examples the demanding policy decisions we face. The first focuses on the basic regulatory function of protecting the public from those who would exploit these fears. The second centers on the well-debated issues of advance directives and euthanasia that surround AD. Although more dialogue, education and research funding are needed to best serve the interests of AD patients and families as well as society at large, this will be challenging because of the strong feelings and divisions AD engenders.
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Affiliation(s)
- Robert H Blank
- Robert H. Blank, Ph.D., is Adjunct Professor of Political Science at the University of Canterbury, Christchurch, New Zealand. He has previously taught at Northern Illinois University; Brunel University in West London, UK; Aarhus University in Aarhus, Denmark; and National Taiwan University in Taipei, Taiwan. He has published over 40 books in health and biomedical policy
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Abstract
OBJECTIVE We test whether nursing homes serving predominately low-income and racial minority residents (compositional explanation) or located in neighborhoods with higher concentrations of low-income and racial minority residents (contextual explanation) have worse financial outcomes and care quality. DATA SOURCES Healthcare Cost Report Information System, Nursing Home Compare, Online Survey Certification and Reporting Certification, and American Community Survey. STUDY DESIGN A cross-sectional study design of nursing homes within U.S. metropolitan areas. DATA COLLECTION/EXTRACTION METHODS Data were obtained from Centers for Medicare & Medicaid Services and U.S. Census Bureau. PRINCIPAL FINDINGS Medicaid-dependent nursing homes have a 3.5 percentage point lower operating ratio. Those serving primarily racial minorities have a 2.64-point lower quality rating. A 1 percent increase in the neighborhood population living in poverty is associated with a 1.20-point lower quality rating, on a scale from 10 to 50, and a 1 percent increase in the portion of neighborhood black residents is associated with a 0.8 percentage point lower operating ratio and a 0.37 lower quality rating. CONCLUSIONS Medicaid dependency (compositional effect) and concentration of racial minority residents in neighborhoods (contextual effect) are associated with higher fiscal stress and lower quality of care, indicating that nursing homes' geographic location may exacerbate long-term care inequalities.
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Affiliation(s)
- Young Joo Park
- Rockefeller Institute of GovernmentState University of New YorkAlbanyNY
| | - Erika G. Martin
- Rockefeller Institute of GovernmentState University of New YorkAlbanyNY
- Rockefeller College of Public Affairs and PolicyUniversity at AlbanyState University of New YorkAlbanyNY
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Baldwin P. CMS Unveils Latest Payment Model for Nursing Facilities. Consult Pharm 2018; 33:404-435. [PMID: 29996969 DOI: 10.4140/tcp.n.2018.404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Kabiri M, Brauer M, Shafrin J, Sullivan J, Gill TM, Goldman DP. Long-Term Health and Economic Value of Improved Mobility among Older Adults in the United States. Value Health 2018; 21:792-798. [PMID: 30005751 PMCID: PMC6078098 DOI: 10.1016/j.jval.2017.12.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 12/18/2017] [Accepted: 12/20/2017] [Indexed: 06/08/2023]
Abstract
BACKGROUND Mobility impairments have substantial physical and mental health consequences, resulting in diminished quality of life. Most studies on the health economic consequences of mobility limitations focus on short-term implications. OBJECTIVES To examine the long-term value of improving mobility in older adults. METHODS Our six-step approach used clinical trial data to calibrate mobility improvements and estimate health economic outcomes using a microsimulation model. First, we measured improvement in steps per day calibrated with clinical trial data examining hylan G-F 20 viscosupplementation treatment. Second, we created a cohort of patients 51 years and older with osteoarthritis. In the third step, we estimated their baseline quality of life. Fourth, we translated steps-per-day improvements to changes in quality of life using estimates from the literature. Fifth, we calibrated quality of life in this cohort to match those in the trial. Last, we incorporated these data and parameters into The Health Economic Medical Innovation Simulation model to estimate how mobility improvements affect functional status limitations, medical expenditures, nursing home utilization, employment, and earnings between 2012 and 2030. RESULTS In our sample of 12.6 million patients, 66.7% were female and 70% had a body mass index of more than 25 kg/m2. Our model predicted that a 554-step-per-day increase in mobility would reduce functional status limitations by 5.9%, total medical expenditures by 0.9%, and nursing home utilization by 2.8%, and increase employment by 2.9%, earnings by 10.3%, and monetized quality of life by 3.2% over this 18-year period. CONCLUSIONS Interventions that improve mobility are likely to reduce long-run medical expenditures and nursing home utilization and increase employment.
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Affiliation(s)
- Mina Kabiri
- Precision Health Economics, 9433 Bee Cave Rd. Suite 252, Austin, TX 78733, 310-984-7375,
| | - Michelle Brauer
- Precision Health Economics, 11100 Santa Monica Blvd. Suite 500, Los Angeles, CA 90025, 310-984-7376,
| | - Jason Shafrin
- Precision Health Economics, 11100 Santa Monica Blvd. Suite 500, Los Angeles, CA 90025, 310-984-7705,
| | - Jeff Sullivan
- Precision Health Economics, 11100 Santa Monica Blvd. Suite 500, Los Angeles, CA 90025, 310-984-7730,
| | - Thomas M. Gill
- Yale School of Medicine, 20 York Street, New Haven, CT 06510,
| | - Dana P. Goldman
- University of Southern California, Schaeffer Center for Health Policy and Economics, 635 Downey Way, Los Angeles, CA 90089-3331, 213-821-7948,
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Bos A, Boselie P, Trappenburg M. Financial performance, employee well-being, and client well-being in for-profit and not-for-profit nursing homes: A systematic review. Health Care Manage Rev 2018; 42:352-368. [PMID: 28885990 DOI: 10.1097/hmr.0000000000000121] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Expanding the opportunities for for-profit nursing home care is a central theme in the debate on the sustainable organization of the growing nursing home sector in Western countries. PURPOSES We conducted a systematic review of the literature over the last 10 years in order to determine the broad impact of nursing home ownership in the United States. Our review has two main goals: (a) to find out which topics have been studied with regard to financial performance, employee well-being, and client well-being in relation to nursing home ownership and (b) to assess the conclusions related to these topics. The review results in two propositions on the interactions between financial performance, employee well-being, and client well-being as they relate to nursing home ownership. METHODOLOGY/APPROACH Five search strategies plus inclusion and quality assessment criteria were applied to identify and select eligible studies. As a result, 50 studies were included in the review. Relevant findings were categorized as related to financial performance (profit margins, efficiency), employee well-being (staffing levels, turnover rates, job satisfaction, job benefits), or client well-being (care quality, hospitalization rates, lawsuits/complaints) and then analyzed based on common characteristics. FINDINGS For-profit nursing homes tend to have better financial performance, but worse results with regard to employee well-being and client well-being, compared to not-for-profit sector homes. We argue that the better financial performance of for-profit nursing homes seems to be associated with worse employee and client well-being. PRACTICAL IMPLICATIONS For policy makers considering the expansion of the for-profit sector in the nursing home industry, our findings suggest the need for a broad perspective, simultaneously weighing the potential benefits and drawbacks for the organization, its employees, and its clients.
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Affiliation(s)
- Aline Bos
- Aline Bos, MSc, is PhD Student, Utrecht University School of Governance, the Netherlands. E-mail: Boselie, PhD, is Professor of Strategic Human Resource Management, Utrecht University School of Governance, the Netherlands.Margo Trappenburg, PhD, is Professor of Social work, University of Humanistic Studies, Utrecht, the Netherlands, and Associate Professor, Utrecht University School of Governance, the Netherlands
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Mommaerts C. Are coresidence and nursing homes substitutes? Evidence from Medicaid spend-down provisions. J Health Econ 2018; 59:125-138. [PMID: 29709710 PMCID: PMC5966342 DOI: 10.1016/j.jhealeco.2018.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 04/06/2018] [Accepted: 04/16/2018] [Indexed: 06/08/2023]
Abstract
This paper measures the extent to which the price of nursing home care affects a potential substitute living arrangement: coresidence with adult children. Exploiting variation in state Medicaid income "spend-down" provisions over time, I find that living in a state with a spend-down provision decreases the prevalence of coresidence with adult children by 1-4 percentage points for single elderly individuals, with a corresponding increase in the use of nursing home care. These findings suggest that changes in Medicaid eligibility for long-term care benefits could have large impacts on living arrangements, care utilization patterns, and Medicaid expenditures.
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McDermott S, Royer J, Mann JR, Armour BS. Factors associated with ambulatory care sensitive emergency department visits for South Carolina Medicaid members with intellectual disability. J Intellect Disabil Res 2018; 62:165-178. [PMID: 29027297 PMCID: PMC5803329 DOI: 10.1111/jir.12429] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 07/07/2017] [Accepted: 09/18/2017] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Ambulatory care sensitive conditions (ACSCs) can be seen as failure of access or management in primary care settings. Identifying factors associated with ACSCs for individuals with an Intellectual Disability (ID) provide insight into potential interventions. METHOD To assess the association between emergency department (ED) ACSC visits and a number of demographic and health characteristics of South Carolina Medicaid members with ID. A retrospective cohort of adults with ID was followed from 2001 to 2011. Using ICD-9-CM codes, four ID subgroups, totalling 14 650 members, were studied. RESULTS There were 106 919 ED visits, with 21 214 visits (19.8%) classified as ACSC. Of those, 82.9% were treated and released from EDs with costs averaging $578 per visit. People with mild and unspecified ID averaged greater than one ED visit per member year. Those with Down syndrome and other genetic cause ID had the lowest rates of ED visits but the highest percentage of ACSC ED visits that resulted in inpatient hospitalisation (26.6% vs. an average of 16.8% for other subgroups). When compared with other residential types, those residing at home with no health support services had the highest ED visit rate and were most likely to be discharged back to the community following an ED visit (85.2%). Adults residing in a nursing home had lower rates of ED visits but were most likely to be admitted to the hospital (38.9%) following an ED visit. Epilepsy and convulsions were the leading cause (29.6%) of ACSC ED visits across all subgroups and residential settings. CONCLUSION Prevention of ACSC ED visits may be possible by targeting adults with ID who live at home without health support services.
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Affiliation(s)
- S McDermott
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA
| | - J Royer
- Revenue and Fiscal Affairs Office, Columbia, SC, USA
| | - J R Mann
- Department of Preventive Medicine, School of Medicine and John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS, USA
| | - B S Armour
- National Center on Birth Defects and Developmental Disabilities (NCBDDD), Centers for Disease Control and Prevention, Atlanta, GA, USA
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Ballard C, Corbett A, Orrell M, Williams G, Moniz-Cook E, Romeo R, Woods B, Garrod L, Testad I, Woodward-Carlton B, Wenborn J, Knapp M, Fossey J. Impact of person-centred care training and person-centred activities on quality of life, agitation, and antipsychotic use in people with dementia living in nursing homes: A cluster-randomised controlled trial. PLoS Med 2018; 15:e1002500. [PMID: 29408901 PMCID: PMC5800565 DOI: 10.1371/journal.pmed.1002500] [Citation(s) in RCA: 122] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 01/04/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Agitation is a common, challenging symptom affecting large numbers of people with dementia and impacting on quality of life (QoL). There is an urgent need for evidence-based, cost-effective psychosocial interventions to improve these outcomes, particularly in the absence of safe, effective pharmacological therapies. This study aimed to evaluate the efficacy of a person-centred care and psychosocial intervention incorporating an antipsychotic review, WHELD, on QoL, agitation, and antipsychotic use in people with dementia living in nursing homes, and to determine its cost. METHODS AND FINDINGS This was a randomised controlled cluster trial conducted between 1 January 2013 and 30 September 2015 that compared the WHELD intervention with treatment as usual (TAU) in people with dementia living in 69 UK nursing homes, using an intention to treat analysis. All nursing homes allocated to the intervention received staff training in person-centred care and social interaction and education regarding antipsychotic medications (antipsychotic review), followed by ongoing delivery through a care staff champion model. The primary outcome measure was QoL (DEMQOL-Proxy). Secondary outcomes were agitation (Cohen-Mansfield Agitation Inventory [CMAI]), neuropsychiatric symptoms (Neuropsychiatric Inventory-Nursing Home Version [NPI-NH]), antipsychotic use, global deterioration (Clinical Dementia Rating), mood (Cornell Scale for Depression in Dementia), unmet needs (Camberwell Assessment of Need for the Elderly), mortality, quality of interactions (Quality of Interactions Scale [QUIS]), pain (Abbey Pain Scale), and cost. Costs were calculated using cost function figures compared with usual costs. In all, 847 people were randomised to WHELD or TAU, of whom 553 completed the 9-month randomised controlled trial. The intervention conferred a statistically significant improvement in QoL (DEMQOL-Proxy Z score 2.82, p = 0.0042; mean difference 2.54, SEM 0.88; 95% CI 0.81, 4.28; Cohen's D effect size 0.24). There were also statistically significant benefits in agitation (CMAI Z score 2.68, p = 0.0076; mean difference 4.27, SEM 1.59; 95% CI -7.39, -1.15; Cohen's D 0.23) and overall neuropsychiatric symptoms (NPI-NH Z score 3.52, p < 0.001; mean difference 4.55, SEM 1.28; 95% CI -7.07,-2.02; Cohen's D 0.30). Benefits were greatest in people with moderately severe dementia. There was a statistically significant benefit in positive care interactions as measured by QUIS (19.7% increase, SEM 8.94; 95% CI 2.12, 37.16, p = 0.03; Cohen's D 0.55). There were no statistically significant differences between WHELD and TAU for the other outcomes. A sensitivity analysis using a pre-specified imputation model confirmed statistically significant benefits in DEMQOL-Proxy, CMAI, and NPI-NH outcomes with the WHELD intervention. Antipsychotic drug use was at a low stable level in both treatment groups, and the intervention did not reduce use. The WHELD intervention reduced cost compared to TAU, and the benefits achieved were therefore associated with a cost saving. The main limitation was that antipsychotic review was based on augmenting processes within care homes to trigger medical review and did not in this study involve proactive primary care education. An additional limitation was the inherent challenge of assessing QoL in this patient group. CONCLUSIONS These findings suggest that the WHELD intervention confers benefits in terms of QoL, agitation, and neuropsychiatric symptoms, albeit with relatively small effect sizes, as well as cost saving in a model that can readily be implemented in nursing homes. Future work should consider how to facilitate sustainability of the intervention in this setting. TRIAL REGISTRATION ISRCTN Registry ISRCTN62237498.
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Affiliation(s)
- Clive Ballard
- Exeter University Medical School, Exeter University, Exeter, United Kingdom
- * E-mail:
| | - Anne Corbett
- Exeter University Medical School, Exeter University, Exeter, United Kingdom
| | - Martin Orrell
- Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Gareth Williams
- Wolfson Centre for Age-Related Diseases, King’s College London, London, United Kingdom
| | - Esme Moniz-Cook
- Faculty of Health and Social Sciences, University of Hull, Hull, United Kingdom
| | - Renee Romeo
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Bob Woods
- Dementia Services Development Centre Wales, Bangor University, Bangor, United Kingdom
| | - Lucy Garrod
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Ingelin Testad
- Exeter University Medical School, Exeter University, Exeter, United Kingdom
- Centre for Age-related Medicine (SESAM), Helse Stavanger University Hospital, Stavanger, Norway
| | | | - Jennifer Wenborn
- Division of Psychiatry, University College London, London, United Kingdom
| | - Martin Knapp
- London School of Economics, London, United Kingdom
| | - Jane Fossey
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
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Lord J, Davlyatov G, Thomas KS, Hyer K, Weech-Maldonado R. The Role of Assisted Living Capacity on Nursing Home Financial Performance. Inquiry 2018; 55:46958018793285. [PMID: 30141704 PMCID: PMC6109846 DOI: 10.1177/0046958018793285] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 07/05/2018] [Accepted: 07/06/2018] [Indexed: 11/16/2022]
Abstract
The rapid growth of the assisted living industry has coincided with decreased levels of nursing home occupancy and financial performance. The purpose of this article is to examine the relationships among assisted living capacity, nursing home occupancy, and nursing home financial performance. In addition, we explore whether the relationship between assisted living capacity and nursing home financial performance is mediated by nursing home occupancy. This research utilized publicly available secondary data, for the state of Florida from 2003 through 2015. General descriptive statistics were used to assess the relationships among financial performance, assisted living capacity, and occupancy. To explore the relationships among financial performance, assisted living capacity and occupancy, and test potential mediation of occupancy, we followed Baron and Kenny's approach and estimated 3 models examining the relationships between (1) assisted living capacity and nursing home financial performance, (2) assisted living capacity and nursing home occupancy, and (3) nursing home occupancy and financial performance after assisted living capacity is included in the model. We used generalized estimating equations, to adjust for repeated measures and to model the above relationships. Year fixed effects control for time trend. The independent variable, assisted living beds, was lagged for 1 year to account for the potential influence on financial performance. The final analytic sample consisted of 7688 nursing home-year observations from 657 unique nursing homes. Our findings suggest that assisted living capacity does have a negative impact on nursing homes' financial performance. Even though, assisted living capacity seems not to significantly decrease nursing home occupancy. The relationship between assisted living capacity and financial performance was not mediated through occupancy. These findings suggest that assisted living communities may not be able to significantly reduce nursing home occupancy; however, the presence of assisted living communities may create additional financial/competitive pressures that result in decreased nursing home financial performance.
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Blackburn J, Zheng Q, Grabowski DC, Hirth R, Intrator O, Stevenson DG, Banaszak-Holl J. Nursing Home Chain Affiliation and Its Impact on Specialty Service Designation for Alzheimer Disease. Inquiry 2018; 55:46958018787992. [PMID: 30047810 PMCID: PMC6077895 DOI: 10.1177/0046958018787992] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 04/24/2018] [Accepted: 06/18/2018] [Indexed: 12/12/2022]
Abstract
Specialty care units (SCUs) in nursing homes (NHs) grew in popularity during the 1990s to attract residents while national policies and treatment paradigms changed. Alzheimer disease has consistently been the dominant form of SCU. This study explored the extent to which chain affiliation, which is common among NHs, affected SCU bed designation. Using data from the Online Survey Certification and Reporting (OSCAR) from 1996 through 2010 with 207 431 NH-year observations, we described trends and compared chain-affiliated NHs with independent NHs. Designation of beds for Alzheimer disease SCUs grew from 1996 to 2003 and then declined. At the peak, 19.6% of all NHs had at least one Alzheimer disease SCU bed. In general, chain affiliation promoted Alzheimer disease SCU bed designation across time, chain size, and NH profit status. During the period of largest growth from 1996 to 2003, the likelihood of designation of Alzheimer disease SCU beds was 1.55 percentage points higher among for-profit NHs affiliated with large chains than independent for-profit NHs ( P < .001) and remained 1.28 percentage points higher from 2004 to 2010. However, chain-affiliated NHs generally had a lower percentage of residents with dementia than independent NHs. For example, although for-profit NHs affiliated with large chains had more Alzheimer disease SCU beds, they had nearly 3% fewer residents with dementia than independent NHs ( P < .001). We conclude that organizational decisions to designate beds for Alzheimer disease SCUs may be related to marketing strategies to attract residents since adoption of Alzheimer disease SCUs has fluctuated over time, but did not appear driven by demand.
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Affiliation(s)
| | | | | | | | - Orna Intrator
- University of Rochester, NY, USA
- VA National Geriatrics & Extended Care Data Analysis Center, Canandaigua NY
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Affiliation(s)
- Penelope Ann Shaw
- a Nursing Home Resident, Braintree , Massachusetts , USA
- b Board Member, Massachusetts Advocates for Nursing Home Reform , Medford , Massachusetts , USA
- c Member, Citizens Advisory Committee , Massachusetts Executive Office of Elder Affairs , Boston , Massachusetts , USA
- d Member, Executive Committee , Disability Policy Consortium , Boston , Massachusetts , USA
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36
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Seiler LW. Long-Term Care: Funding of Long-Term Care. Issue Brief Health Policy Track Serv 2017; 2017:1-81. [PMID: 29360305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Baldwin P. Congress Quiet on Long-Term Care, but Agencies Continue to Work. Consult Pharm 2017; 32:772. [PMID: 29467070 DOI: 10.4140/tcp.n.2017.772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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38
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McMillen DP, Powers ET. The eldercare landscape: Evidence from California. Health Econ 2017; 26 Suppl 2:139-157. [PMID: 28940921 DOI: 10.1002/hec.3567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 06/19/2017] [Accepted: 06/30/2017] [Indexed: 06/07/2023]
Abstract
Although the literature suggests that nursing home location is instrumental to the efficient functioning of the long-term care industry, there has been little research directly focused on the spatial distribution of nursing homes. We discuss factors that may influence nursing home location choice, emphasizing agglomeration economies around hospitals. We estimate econometric models of location using information on all freestanding, MediCal-licensed long-term care facilities in the state of California. We find that nursing homes are more likely to locate in the same Census tract as a hospital and are more likely to locate in tracts nearer to those containing a hospital.
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Affiliation(s)
- Daniel P McMillen
- Department of Economics, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Elizabeth T Powers
- Department of Economics, Institute of Government and Public Affairs, University of Illinois at Urbana-Champaign, Urbana, IL, USA
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Miller SC, Lima JC, Intrator O, Martin E, Bull J, Hanson LC. Specialty Palliative Care Consultations for Nursing Home Residents With Dementia. J Pain Symptom Manage 2017; 54:9-16.e5. [PMID: 28438589 PMCID: PMC5663286 DOI: 10.1016/j.jpainsymman.2017.03.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 02/20/2017] [Accepted: 03/17/2017] [Indexed: 12/22/2022]
Abstract
CONTEXT U.S. nursing home (NH) residents with dementia have limited access to specialty palliative care beyond Medicare hospice. OBJECTIVES The objective of this study was to examine the value of expanded palliative care access for NH residents with moderate-to-very severe dementia. METHODS We merged palliative care consultation data in 31 NHs in two states to Medicare data to identify residents with consultations, moderate-to-very severe dementia, and deaths in 2006-2010. Initial palliative consultations were identified as occurring later and earlier (1-30 days and 31-180 days before death, respectively). Three controls for each consultation recipient were selected using propensity score matching. Weighted multivariate analyses evaluated the effect of consultations on hospital or acute care use seven and 30 days before death and on (potentially) burdensome transitions (i.e., hospital or hospice admission three days before death or two plus acute care transitions 30 days before death). RESULTS With earlier consultation (vs. no consultation), hospitalization rates in the seven days before death were on average 13.2 percentage points lower (95% confidence interval [CI] -21.8%, -4.7%) and with later consultation 5.9 percentage points lower (95% CI -13.7%, +4.9%). For earlier consultations (vs. no consultations), rates were 18.4 percentage points lower (95% CI -28.5%, -8.4%) for hospitalizations and 11.9 lower (95% CI -20.7%, -3.1%) for emergency room visits 30 days before death; they were 20.2 percentage points lower (95% CI -28.5%, -12.0%) for burdensome transitions. CONCLUSION Consultations appear to reduce acute care use and (potentially) burdensome transitions for dying residents with dementia. Reductions were greater when consultations were earlier.
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Affiliation(s)
- Susan C Miller
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA; Center for Gerontology and Health Care Research, Brown University School of Public Health, Providence, Rhode Island, USA.
| | - Julie C Lima
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA; Center for Gerontology and Health Care Research, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Orna Intrator
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York, USA; Geriatrics and Extended Care Data and Analyses Center, Canandaigua Veterans Administration Medical Center, Canandaigua, New York, USA
| | - Edward Martin
- Department of Medicine, Brown University, Providence, Rhode Island, USA; Hope Hospice and Palliative Care, Providence, Rhode Island, USA
| | - Janet Bull
- Four Seasons, Flat Rock, North Carolina, USA
| | - Laura C Hanson
- Division of Geriatric Medicine, Center for Aging and Health, Palliative Care Program, University of North Carolina, Chapel Hill, North Carolina, USA
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Jutkowitz E, Kuntz KM, Dowd B, Gaugler JE, MacLehose RF, Kane RL. Effects of cognition, function, and behavioral and psychological symptoms on out-of-pocket medical and nursing home expenditures and time spent caregiving for persons with dementia. Alzheimers Dement 2017; 13:801-809. [PMID: 28161279 PMCID: PMC5644025 DOI: 10.1016/j.jalz.2016.12.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 08/24/2016] [Accepted: 12/21/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Clinical features of dementia (cognition, function, and behavioral and psychological symptoms) may differentially affect out-of-pocket medical and nursing home (NH) expenditures and informal care received (outcomes). METHODS We used cross-sectional data (Aging, Demographics, and Memory Study) to estimate probabilities of experiencing outcomes by clinical features. For those experiencing an outcome, we estimated effects of clinical features on the amount of the outcome. RESULTS No clinical feature predicted the probability of having out-of-pocket medical expenditures. For those with medical expenditures, higher cognition and poorer function were associated with more spending. Poorer function predicted having out-of-pocket NH expenditures. For those with NH expenditures, no clinical feature predicted the amount. Poorer function and a greater number of behavioral and psychological symptoms predicted the probability of receiving caregiving. For those receiving care, poorer function was associated with more caregiving. CONCLUSIONS Clinical features differentially impact outcomes with poorer function associated with all types of costs and caregiving received.
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Affiliation(s)
- Eric Jutkowitz
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA.
| | - Karen M Kuntz
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Bryan Dowd
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Joseph E Gaugler
- Adult & Gerontological Health Co-Operative, School of Nursing, University of Minnesota, Minneapolis, MN, USA
| | - Richard F MacLehose
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Robert L Kane
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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Thiele D. [In process]. Pflege Z 2017; 70:22-24. [PMID: 29419966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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van Noort O, Schotanus F, van de Klundert J, Telgen J. Explaining regional variation in home care use by demand and supply variables. Health Policy 2017; 122:140-146. [PMID: 29122376 DOI: 10.1016/j.healthpol.2017.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 04/30/2017] [Accepted: 05/08/2017] [Indexed: 11/15/2022]
Abstract
In the Netherlands, home care services like district nursing and personal assistance are provided by private service provider organizations and covered by private health insurance companies which bear legal responsibility for purchasing these services. To improve value for money, their procurement increasingly replaces fee-for-service payments with population based budgets. Setting appropriate population budgets requires adaptation to the legitimate needs of the population, whereas historical costs are likely to be influenced by supply factors as well, not all of which are necessarily legitimate. Our purpose is to explain home care costs in terms of demand and supply factors. This allows for adjusting historical cost patterns when setting population based budgets. Using expenses claims of 60 Dutch municipalities, we analyze eight demand variables and five supply variables with a multiple regression model to explain variance in the number of clients per inhabitant, costs per client and costs per inhabitant. Our models explain 69% of variation in the number of clients per inhabitant, 28% of costs per client and 56% of costs per inhabitant using demand factors. Moreover, we find that supply factors explain an additional 17-23% of variation. Predictors of higher utilization are home care organizations that are integrated with intramural nursing homes, higher competition levels among home care organizations and the availability of complementary services.
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Affiliation(s)
- Olivier van Noort
- University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands.
| | - Fredo Schotanus
- University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands.
| | | | - Jan Telgen
- University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands.
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Easton T, Milte R, Crotty M, Ratcliffe J. Where's the evidence? a systematic review of economic analyses of residential aged care infrastructure. BMC Health Serv Res 2017; 17:226. [PMID: 28327120 PMCID: PMC5361718 DOI: 10.1186/s12913-017-2165-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 03/15/2017] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Residential care infrastructure, in terms of the characteristics of the organisation (such as proprietary status, size, and location) and the physical environment, have been found to directly influence resident outcomes. This review aimed to summarise the existing literature of economic evaluations of residential care infrastructure. METHODS A systematic review of English language articles using AgeLine, CINAHL, Econlit, Informit (databases in Health; Business and Law; Social Sciences), Medline, ProQuest, Scopus, and Web of Science with retrieval up to 14 December 2015. The search strategy combined terms relating to nursing homes, economics, and older people. Full economic evaluations, partial economic evaluations, and randomised trials reporting more limited economic information, such as estimates of resource use or costs of interventions were included. Data was extracted using predefined data fields and synthesized in a narrative summary to address the stated review objective. RESULTS Fourteen studies containing an economic component were identified. None of the identified studies attempted to systematically link costs and outcomes in the form of a cost-benefit, cost-effectiveness, or cost-utility analysis. There was a wide variation in approaches taken for valuing the outcomes associated with differential residential care infrastructures: 8 studies utilized various clinical outcomes as proxies for the quality of care provided, and 2 focused on resident outcomes including agitation, quality of life, and the quality of care interactions. Only 2 studies included residents living with dementia. CONCLUSIONS Robust economic evidence is needed to inform aged care facility design. Future research should focus on identifying appropriate and meaningful outcome measures that can be used at a service planning level, as well as the broader health benefits and cost-saving potential of different organisational and environmental characteristics in residential care. TRIAL REGISTRATION International Prospective Register of Systematic Reviews (PROSPERO) registration number CRD42015015977 .
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Affiliation(s)
- Tiffany Easton
- Flinders Health Economics Group, School of Medicine, Flinders University, Adelaide, SA Australia
- NHMRC Partnership Centre on Dealing with Cognitive and Related Functional Decline in Older People, Canberra, Australia
- Rehabilitation, Aged and Extended Care, School of Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA 5001 Australia
| | - Rachel Milte
- NHMRC Partnership Centre on Dealing with Cognitive and Related Functional Decline in Older People, Canberra, Australia
- Rehabilitation, Aged and Extended Care, School of Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA 5001 Australia
- Institute for Choice, Business School, University of South Australia, Adelaide, SA Australia
| | - Maria Crotty
- NHMRC Partnership Centre on Dealing with Cognitive and Related Functional Decline in Older People, Canberra, Australia
- Rehabilitation, Aged and Extended Care, School of Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA 5001 Australia
| | - Julie Ratcliffe
- NHMRC Partnership Centre on Dealing with Cognitive and Related Functional Decline in Older People, Canberra, Australia
- Institute for Choice, Business School, University of South Australia, Adelaide, SA Australia
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Evans N. How care homes are being short-changed. Nurs Older People 2017; 29:8-9. [PMID: 28244356 DOI: 10.7748/nop.29.2.8.s8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In England, four in ten care home residents pay the full cost of their care. But new research from analysts LaingBuisson suggests they may also be paying for the care of those who get help from the state.
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Lung T, Howard K, Etherton-Beer C, Sim M, Lewin G, Arendts G. Comparison of the HUI3 and the EQ-5D-3L in a nursing home setting. PLoS One 2017; 12:e0172796. [PMID: 28234983 PMCID: PMC5325524 DOI: 10.1371/journal.pone.0172796] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 02/09/2017] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Accurately assessing changes in the quality of life of older people living permanently in nursing homes is important. The multi-attribute utility instrument most commonly used and recommended to assess health-related quality of life in the nursing home population is the three-level EuroQol EQ-5D-3L. To date, there have been no studies using the Health Utilities Index Mark III (HUI3). The purpose of this study was to compare the level of agreement and sensitivity to change of the EQ-5D-3L and HUI3 in a nursing home population. METHODS EQ-5D-3L and HUI3 scores were measured as part of a cluster randomised controlled trial of nurse led care coordination in a nursing home population in Perth, Western Australia at baseline and 6-month follow up. RESULTS Both measures were completed for 199 residents at baseline and 177 at 6-month follow-up. Mean baseline utility scores for EQ-5D-3L (0.45; 95% CI 0.41-0.49) and HUI3 (0.15; 95% CI 0.10-0.20) were significantly different (Wilcoxon signed rank test, p<0.01) and agreement was poor to moderate between absolute scores from each instrument (intra-class correlation coefficient = 0.63). The EQ-5D-3L appeared more sensitive to change over the 6-month period. CONCLUSION Our findings show that the EQ-5D-3L and HUI3 estimate different utility scores among nursing home residents. These differences should be taken into account, particularly when considering the implications of the cost-effectiveness of particular interventions and we conclude that the HUI3 is no better suited to measuring health-related quality of life in a nursing home population when compared to the EQ-5D-3L.
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Affiliation(s)
- Tom Lung
- The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia
- Sydney Medical School, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Kirsten Howard
- Sydney Medical School, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Christopher Etherton-Beer
- School of Medicine and Pharmacology Royal Perth Hospital Unit, The University of Western Australia, Crawley, Western Australia, Australia
| | - Moira Sim
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Gill Lewin
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
| | - Glenn Arendts
- Emergency Medicine, School of Primary, Aboriginal and Rural Health Care, The University of Western Australia, Crawley, Western Australia, Australia
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Affiliation(s)
- Alison While
- Emeritus Professor of Community Nursing, King's College London, Florence Nightingale Faculty of Nursing and Midwifery and Fellow of the QNI
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Bos A, Harrington C. What Happens to a Nursing Home Chain When Private Equity Takes Over? A Longitudinal Case Study. Inquiry 2017; 54:46958017742761. [PMID: 29161948 PMCID: PMC5798733 DOI: 10.1177/0046958017742761] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 09/15/2017] [Accepted: 10/09/2017] [Indexed: 11/17/2022]
Abstract
We analyzed what happens to a nursing home chain when private equity takes over, with regard to strategy, financial performance, and resident well-being. We conducted a longitudinal (2000-2012) case study of a large nursing home chain that triangulated qualitative and quantitative data from 5 different data sources. Results show that private equity owners continued and reinforced several strategies that were already put in place before the takeover, including a focus on keeping staffing levels low; the new owners added restructuring, rebranding, and investment strategies such as establishing new companies, where the nursing home chain served as an essential "launch customer."
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Fleming JA. Medicaid Provider Tax. Issue Brief Health Policy Track Serv 2016; 2016:1-17. [PMID: 28248071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Seiler LW, Mortenson LC. Long-Term Care: Home- and Community-Based Services. Issue Brief Health Policy Track Serv 2016; 2016:1-54. [PMID: 28252883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Huang SS, Hirth RA. Quality rating and private-prices: Evidence from the nursing home industry. J Health Econ 2016; 50:59-70. [PMID: 27693892 DOI: 10.1016/j.jhealeco.2016.08.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 05/29/2016] [Accepted: 08/28/2016] [Indexed: 06/06/2023]
Abstract
We use the rollout of the five-star rating of nursing homes to study how private-pay prices respond to quality rating. We find that star rating increases the price differential between top- and bottom-ranked facilities. On average, prices of top-ranked facilities increased by 4.8 to 6.0 percent more than the prices of bottom-ranked facilities. We find stronger price effects in markets that are less concentrated where consumers may have more choices of alternative nursing homes. Our results suggest that with simplified design and when markets are less concentrated, consumers are more responsive to quality reporting.
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