Details
| Original language | English |
|---|---|
| Pages (from-to) | 1618-1632 |
| Number of pages | 15 |
| Journal | Health Economics (United Kingdom) |
| Volume | 31 |
| Issue number | 8 |
| Publication status | Published - 5 Jul 2022 |
Abstract
Many countries limit public and private reimbursement for nursing care costs for social or financial reasons. Still, quality varies across nursing homes. We explore the causal link between case-mix adjusted nurse staffing ratios as an indicator of care quality and different price components in Swiss nursing homes. The Swiss reimbursement system limits and subsidizes the care price at the cantonal level, which implicitly limits staffing ratios, while the residents cover the nursing home-specific lodging price privately. To estimate causal effects, we exploit (i) the exogeneity of the Swiss care price regulation, (ii) nursing-home fixed effects estimations and (iii) instrumental variables for the lodging price. Our estimates show a positive impact of prices on certified staffing ratios. We find that a 10% increase in care prices increases certified staffing ratios by 3–4%. A comparable 10% increase in lodging prices raises certified staffing ratios by 1.5–10% (depending on the model). Our findings highlight that price limits for nursing care impose a limit on staffing ratios. Furthermore, our results indicate that providers circumvent price limits by increasing lodging prices that are privately covered. Thus, this cost shifting implicitly shifts the financial burden to the residents.
Keywords
- care quality, long-term care, nursing home, prices, staffing ratios
ASJC Scopus subject areas
- Medicine(all)
- Health Policy
Sustainable Development Goals
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In: Health Economics (United Kingdom), Vol. 31, No. 8, 05.07.2022, p. 1618-1632.
Research output: Contribution to journal › Article › Research › peer review
}
TY - JOUR
T1 - Paying for the view?
T2 - How nursing home prices affect certified staffing ratios
AU - Heger, Dörte
AU - Herr, Annika
AU - Mensen, Anne
N1 - Funding Information: We would like to thank Maximilian Lückemann, Ingo Kolodziej, Thorben Korfhage, Ansgar Wübker and Christian Schmid for helpful comments and suggestions. Dörte Heger and Anne Mensen gratefully acknowledge funding by the Leibniz Science Campus Ruhr. Annika Herr gratefully acknowledges funding by the Federal Ministry of Education and Research (FKZ: 01EH1602B), Germany. Open access funding enabled and organized by Projekt DEAL.
PY - 2022/7/5
Y1 - 2022/7/5
N2 - Many countries limit public and private reimbursement for nursing care costs for social or financial reasons. Still, quality varies across nursing homes. We explore the causal link between case-mix adjusted nurse staffing ratios as an indicator of care quality and different price components in Swiss nursing homes. The Swiss reimbursement system limits and subsidizes the care price at the cantonal level, which implicitly limits staffing ratios, while the residents cover the nursing home-specific lodging price privately. To estimate causal effects, we exploit (i) the exogeneity of the Swiss care price regulation, (ii) nursing-home fixed effects estimations and (iii) instrumental variables for the lodging price. Our estimates show a positive impact of prices on certified staffing ratios. We find that a 10% increase in care prices increases certified staffing ratios by 3–4%. A comparable 10% increase in lodging prices raises certified staffing ratios by 1.5–10% (depending on the model). Our findings highlight that price limits for nursing care impose a limit on staffing ratios. Furthermore, our results indicate that providers circumvent price limits by increasing lodging prices that are privately covered. Thus, this cost shifting implicitly shifts the financial burden to the residents.
AB - Many countries limit public and private reimbursement for nursing care costs for social or financial reasons. Still, quality varies across nursing homes. We explore the causal link between case-mix adjusted nurse staffing ratios as an indicator of care quality and different price components in Swiss nursing homes. The Swiss reimbursement system limits and subsidizes the care price at the cantonal level, which implicitly limits staffing ratios, while the residents cover the nursing home-specific lodging price privately. To estimate causal effects, we exploit (i) the exogeneity of the Swiss care price regulation, (ii) nursing-home fixed effects estimations and (iii) instrumental variables for the lodging price. Our estimates show a positive impact of prices on certified staffing ratios. We find that a 10% increase in care prices increases certified staffing ratios by 3–4%. A comparable 10% increase in lodging prices raises certified staffing ratios by 1.5–10% (depending on the model). Our findings highlight that price limits for nursing care impose a limit on staffing ratios. Furthermore, our results indicate that providers circumvent price limits by increasing lodging prices that are privately covered. Thus, this cost shifting implicitly shifts the financial burden to the residents.
KW - care quality
KW - long-term care
KW - nursing home
KW - prices
KW - staffing ratios
UR - http://www.scopus.com/inward/record.url?scp=85130418049&partnerID=8YFLogxK
U2 - 10.1002/hec.4532
DO - 10.1002/hec.4532
M3 - Article
C2 - 35581684
AN - SCOPUS:85130418049
VL - 31
SP - 1618
EP - 1632
JO - Health Economics (United Kingdom)
JF - Health Economics (United Kingdom)
SN - 1057-9230
IS - 8
ER -