 | The 131st Annual Meeting (November 15-19, 2003) of APHA |
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| The 131st Annual Meeting (November 15-19, 2003) of APHA |
Dana B. Mukamel, PhD, Department of Community and Preventive Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Box 644, Rochester, NY 14642, (585) 275-1985, dana_mukamel@urmc.rochester.edu, William Spector, PhD, Center for Organization and Delivery Studies, Agency for Healthcare Research and Quality, 2101 East Jefferson Street, Suite 605, Rockville, MD 20852, and Alina Bajorska, Department of Community and Preventive Medicine, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Box 644, Rochester, NY 14642.
Nursing home markets have become increasingly more competitive. We hypothesize that competition among nursing homes has refocused on hotel services and amenities rather than clinical services because these are easier for consumers to evaluate. The objective of this study is to investigate whether resources shifted toward hotel and administrative services and away form clinical services. We estimated separate cost functions for clinical care and hotel services for nursing homes in New York State in 1991, 1996 and 1999. The dependent variable was the log of expenditures. Independent variables included logged case mix adjusted days, logged wages by category, ownership, year, competition, and year*competition interactions. The error covariance matrix accounted for clustering of observations for the same facility, allowing for an unstructured specification within the cluster and different covariance parameters by ownership type. We found that the marginal cost of hotel services with respect to competition increased significantly between 1991 and 1996 by a factor of 4.11 (p=0.04), and between 1991 and 1999 by a factor of 6.81 (p=0.00). On the other hand, the marginal cost of clinical services with respect to competition have declined during the same period, although the decline was not significantly different from zero, by a factor of 0.88 (p=0.55) in 1996 and 0.70 (p=0.16) in 1999. These findings, that nursing homes in more competitive markets have shifted resources away from clinical care activities into hotel services raises concerns about the potential for deterioration in the quality of clinical care.
Learning Objectives:
Keywords: Nursing Homes, Quality of Care
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.