Changing the way the elderly live: Evidence from the home health care market in the United States

Orsini, Chiara

doi:10.1016/j.jpubeco.2009.10.010

Cited by 36 publications

(29 citation statements)

References 17 publications

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“…12 The first challenge is then to identify an appropriate agency-specific measure of 1994 average per-patient cost. McKnight (2006) proposed the average number of Medicare visits per patient as a measure of per-patient cost of providing Medicare home health care services, and this measure has been used also by Golberstein et al (2009) andOrsini (2010). In this paper, I follow the previous literature and use the following measure of average per patient cost in 1994:…”

Section: Ownership and Exit Behaviormentioning

confidence: 99%

“…First, although previous literature on the IPS and home health care has exploited time-series (Horwitz 2005;Horwitz and Nichols 2009), and time-series and cross-sectional variation at the state level to study the impact of the IPS on several outcomes (McKnight 2006;Golberstein et al 2009;Orsini 2010), my study is the first study to use time-series and cross-sectional variation at the agency level. Also, previous literature was interested in changes in offerings by hospitals of home health care by ownership status (Horwitz 2005;Horwitz and Nichols 2009).…”

Section: Introductionmentioning

confidence: 99%

“…McKnight (2006) did not find that the IPS impacted measures of health and mortality of Medicare beneficiaries. However, Golberstein et al (2009) finds that the IPS caused an increase in informal care, and Orsini (2010) finds that the IPS caused Medicare beneficiaries to give up independent living. Golberstein et al (2009) and Orsini (2010) also find that poor Medicare beneficiaries were disproportionally affected by the IPS.…”

Section: Introductionmentioning

confidence: 99%

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Ownership and Exit Behavior: Evidence from the Home Health Care Market

Orsini

2015

The B.E. Journal of Economic Analysis &Amp; Policy

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In the US health care system a high fraction of suppliers are not-for-profit companies. Some argue that non-profits are "for-profits in disguise" and I test this proposition in a quasi-experimental way by examining the exit behavior of home health care firms after a legislative change considerably reduced reimbursed visits per patient. The change allows me to construct a cross provider measure of restriction in reimbursement and to use this measure and time-series variation due to the passage of the law in my estimates. I find that exits among for-profit firms are higher than those of not-for-profit firms, rejecting the null that these sectors responded to the legislation in similar ways. In addition, my results expand the view that "not-for-profit" firms are a form of "trapped capital." There is little capital investment in the home health care market, so the higher exit rates of for-profit firms after the law change indicate the possible role of labor inputs in generating differences in exit behavior across sectors.Keywords: long-term care, government restriction in Financing, not-for-profit JEL codes: I11, L31, H32 IntroductionA large fraction of firms in the United States operate as non-profits, coexisting with for-profit and government firms. For example, in 2008, there were 1.58 million non-profit organizations in the United States.Despite the large presence of non-profit firms in health care and other industries, such as education and the arts, there is little consensus on the reasons behind the existence of the non-profit sector (Gertler and Kuan 2009).In health care, the focus of this study, the debate regarding whether nonprofit firms maximize additional outcomes other than profits is fueled by empirical research that often finds few differences in responses to financial incentives *Corresponding author: Chiara Orsini, London School of Economics and Political Science, UK, E-mail: chrorsini@gmail.com BE J. Econ. Anal. Policy 2016; 16(1): 289-320 Brought to you by | London School of Economics and Political Science Authenticated Download Date | 2/9/16 4:38 PM between the two organizational types. These findings are consistent with the idea that "non-profit" might just be a label used by non-profit firms in order to enjoy the advantage of tax-free status so that, in the end, non-profit firms are just "for-profit in disguise" (Weisbrod 1988(Weisbrod , 1998.Here I concentrate on studying exit behavior by for-profit/not-for-profit status in the home health care market. The main contribution of this study is to provide the first causal estimate of the impact of limits in reimbursement on exit rates of for-profit and not-for-profit home health agencies. I find that exit rates for for-profit agencies are higher than exit rates for not-for-profit agencies as a consequence of the imposition of limits in reimbursement from the government, thereby rejecting the hypothesis that not-for-profit home health agencies are "for-profits in disguise" in their exit behavior.Looking at differential exit behavior b...

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Section: Ownership and Exit Behaviormentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Ownership and Exit Behavior: Evidence from the Home Health Care Market

Orsini

2015

The B.E. Journal of Economic Analysis &Amp; Policy

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“…En el ámbito empresarial,los artículos analizados se centran en el estudio de empresas que actúan en un país concreto: Estados Unidos (Orsini, 2010), Japón (Abe, 2007;Kuwahara, Nagata, Taguchi, Naruse, Kawaguchi & Murashima, 2013), Suiza (Stolt, Blomqvist & Winblad, 2011) y España (Monllau Jaques & Rodríguez Ávila, 2013).…”

Section: Carácter Multidisciplinar Del Conocimiento Del Sectorunclassified

The policies of social welfare produced effects in performance of the company? Comparative analysis of European companies

Monllau

Rodríguez

2014

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ResumenObjeto: Analizar y estudiar si las políticas sociales de bienestar repercuten en la eficacia y eficiencia de las empresas que prestan servicios a las personas con dependencia (Código CNAE 87 y 88).Diseño/metodología/enfoque: Para la realización del estudio se han comparado las empresas de los sectores que dan servicios en países que presentan pautas diferentes a la hora de aplicar determinadas políticas sociales. En concreto se han comparado las empresas que actúan en España, Alemania, Inglaterra y los Países Bajos. Los datos se han obtenido a partir de la base de datos AMADEUS. Se ha tomado como período de referencia el 2008-2012. Las variables utilizadas han sido la tasa de margen operativo (TMO) y la tasa de rotación de activos (TRA). Aportaciones y resultados:De los resultados obtenidos no se ha podido establecer una relación estadísticamente significativa entre la eficacia y eficiencia de las empresas que prestan servicios a personas con dependencia y las políticas sociales desarrolladas desde los gobiernos.Originalidad / Valor añadido: : Hasta el presente existen pocos estudios sobre el comportamiento financiero de las empresas que prestan servicios a la tercera edad. El desarrollo empresarial de estas actividades implica un crecimiento de la actividad económica que compensa los costes que comporta el crecimiento de la población.

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“…A complementary approach has also investigated whether public home care subsidies reduce nursing home use, or simply crowd out informal care (Hoerger et al, 1996;Pezzin and Schone, 1997). The main question is whether these subsidies affect co-residence (Orsini, 2010), which often reflects macro-structural factors as well and is viewed as a reaction to economic insecurity and social uncertainties (Isengard and Szydlik, 2012). Moreover, a number of studies has specifically focused on the relationship between informal and institutional care and they do not always agree on whether help from family members affects nursing home admissions (Hanley et al, 1990;Boaz and Muller, 1994;Lo Sasso and Johnson, 2002;Paraponaris et al, 2012).…”

Section: Introductionmentioning

confidence: 99%