Quality-adjusted Cost Functions and Policy Evaluation in the Nursing Home Industry

Gertler, Paul; Waldman, Donald M.

doi:10.1086/261859

Cited by 114 publications

(87 citation statements)

References 25 publications

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“…While this is striking, caution is needed in interpreting this difference. The difference in costs could relate to differences in treatment intensity, provider efficiency, or other institutional factors [30]. It could also relate, in part, to problems with comparing cost-adjusted charges and costs, or in using the CPI to inflate the 1999 UDSMR data to 2001 dollars, the year of the VA data.…”

Section: Discussionmentioning

confidence: 99%

Cost of inpatient rehabilitation care in the Department of Veterans Affairs

Richardson¹,

Vogel²,

Wing³

et al. 2006

JRRD

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Abstract-We investigated the determinants of inpatient rehabilitation costs in the Department of Veterans Affairs (VA) and examined the relationship between length of stay (LOS) and discharge costs using data from VA and community rehabilitation hospitals. We estimated regression models to identify patient characteristics associated with specialized inpatient rehabilitation costs. VA data included 3,535 patients discharged from 63 facilities in fiscal year 2001. We compared VA costs to community rehabilitation hospitals using a sample from the Uniform Data System for Medical Rehabilitation of 190,112 patients discharged in 1999 from 697 facilities. LOS was a strong predictor of cost for VA and non-VA hospitals. Functional status, measured by Functional Independence Measure (FIM) scores at admission, was statistically significant but added little explanatory value after controlling for LOS. Although FIM scores were associated with LOS, FIM scores accounted for little variance in cost after controlling for LOS. These results are most applicable to researchers conducting cost-effectiveness analyses.

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Section: Discussionmentioning

confidence: 99%

Cost of inpatient rehabilitation care in the Department of Veterans Affairs

Richardson¹,

Vogel²,

Wing³

et al. 2006

JRRD

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show abstract

“…More recently, attention has been devoted to the understanding of cost reduction achievements. Improved methods to control for changes in quality and to cope with the potential endogeneity of output and/or quality in cost functions have been proposed (Gertler and Waldman, 1992;Chen and Shea, 2002). Also, direct assessment of the impact of PPS on quality (Konetzka et al, 2004;Konetzka et al, 2006) and access to nursing care (Coburn et al, 1993) have been carried out.…”

Section: Previous Research On the Impact Of Pps In Nursing Home Carementioning

confidence: 99%

Implications of global budget payment system on nursing home costs

2014

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Pressure on health care systems due to the increasing expenditures of the elderly population is pushing policy makers to adopt new regulation and payment schemes for nursing home services. We consider the behavior of nonpro…t nursing homes under di¤erent payment schemes and empirically investigate the implications of prospective payments on nursing home costs under tightly regulated quality aspects. To evaluate the impact of the policy change introduced in 2006 in Southern Switzerland -from retrospective to prospective payment -we use a panel of 41 homes observed over a 10-years period (2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010). We employ a …xed e¤ects model with a time trend that is allowed to change after the policy reform. There is evidence that the new payment system slightly reduces costs without impacting quality.

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“…Assuming the presence of endogenous and unobserved quality, Gertler and Waldman (1992) investigate the effect of cost-saving public policies on the quality of nursing homes using the survey data of New York State. They find that the increases in competition are associated with higher levels of both quality and cost, and that a 1 standard deviation reduction in competition will reduce costs by about 20 percent but reduce quality by only 2.5 percent.…”

Section: Previous Researchmentioning

confidence: 99%