Estimating Nursing Home Quality with Selection

Health Care Centralization: The Health Impacts of Obstetric Unit Closures in the Us

“…Our work fits with a broader literature within health economics examining provider exits in health care, including physicians (Sabety, 2022), nursing homes (Olenski, 2022), family planning clinics (Fischer et al, 2018), and hospitals (Carroll, 2022;Gujral and Basu, 2019;Avdic, 2016;Buchmueller et al, 2006). Most related to our own work, the hospital closure literature highlights two important sources of heterogeneity in the effects-the urbanicity of the area and the urgency of health care.…”

Producing Health: Measuring Value Added of Nursing Homes

“…In addition to the Dartmouth Atlas literature, our paper relates to several other distinct literatures. It complements the literature on value added for hospitals (e.g., Geweke et al 2003;Chandra et al 2016;Doyle et al 2019;Hull 2020) and nursing homes (e.g., Olenski and Sacher 2022) which, like most of the prior health literature, has focused on mortality as the single outcome. Our paper also contributes to a growing literature in health economics on nursing home behavior (e.g., Grabowski et al 2008;Hackmann 2019;Gandhi 2020;Gandhi et al 2021;Gupta et al 2021;Hackmann et al 2021) and a literature in health services research that examines cross-sectional variation in nursing home process measures and outcomes (e.g., Castle and Ferguson 2010;Morris et al 2018).…”

Medicare Advantage growth and skilled nursing facility finances

“…12 Past research suggests that payment rates-in both Medicare and Medicaid-are likely the most important determinant of nursing home quality and an important lever for ensuring nursing homes do not close. [31][32][33][34][35] The rapid rise of MA is a shock to this fragile long-term care financing system. While MedPAC has argued that some MAdriven changes, like lower payments for Medicare patients in MA may be appropriate given the high margins facilities receive on Medicare patients, our results highlight the substantial systemwide implications of changes in Medicare when Medicare rates are used to subsidize all types of long-term care.…”

“…The system of de facto subsidization of Medicaid is inefficient, inequitable, and poorly targeted: facilities the most reliant on Medicaid receive the smallest benefit from high Medicare rates and the size of the effective subsidy from high Medicare rates does not vary with a states' Medicaid rates 12 . Past research suggests that payment rates—in both Medicare and Medicaid—are likely the most important determinant of nursing home quality and an important lever for ensuring nursing homes do not close 31–35 . The rapid rise of MA is a shock to this fragile long‐term care financing system.…”