Has the Medicare Prospective Payment System Led to Increased Nursing Home Efficiency?

Zhang, Ning Jackie; Unruh, Lynn; Wan, Thomas T. H.

doi:10.1111/j.1475-6773.2007.00798.x

Cited by 32 publications

(50 citation statements)

References 36 publications

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“…More recently, Bates et al [3] also find an inverse relationship between proxies for quality and efficiency in the context of hospital services in the second stage of the analysis. Zhang et al [40] find that higher nurse staffing is inversely related to efficiency but not when controls are made for quality. Prior [25] also addresses quality in the context of the efficient production of health care services while Sherman and Zhu [31] make a strong case for quality-adjusted DEA (or Q-DEA).…”

Section: Resultsmentioning

confidence: 98%

Explaining the efficiency of local health departments in the U.S.: an exploratory analysis

Mukherjee

Santerre

Zhang

2010

Health Care Manag Sci

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No study to date has analyzed the efficiency at which local health departments (LHDs) produce public health services. As a result, this study employs data envelopment analysis (DEA) to explore the relative technical efficiency of LHDs operating in the United States using 2005 data. The DEA indicates that the typical LHD operates with about 28% inefficiency although inefficiency runs as high as 69% for some LHDs. Multiple regression analysis reveals that more centralized and urban LHDs are less efficient at producing local public health services. The findings also suggest that efficiency is higher for LHDs that produce a greater variety of services internally and rely more on internal funding. However, because this is the first study of LHD efficiency and some shortcomings exist with the available data, we are reluctant to draw strong policy conclusions from the analysis.

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Section: Resultsmentioning

confidence: 98%

Explaining the efficiency of local health departments in the U.S.: an exploratory analysis

Mukherjee

Santerre

Zhang

2010

Health Care Manag Sci

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“…This kind of measure has been employed both in DEA and non-DEA studies about efficiency and quality of care in nursing homes, moreover in those situations where data about outcome were not available or enough reliable (e.g. Lee et al [3], Zhang et al [4], Cheesteen et al [10]). …”

Section: Literature Reviewmentioning

confidence: 99%

“…Despite that, even a cursory review would identify that several studies have already investigated the various factors, such as size, ownership, staffing, reimbursement system and other policy interventions, may influence the efficiency and quality of care in nursing homes. These studies have applied different approaches to investigate the capability of nursing homes to deliver high quality and efficient care to residents, like as the Data Envelopment Analysis [2][3][4], the Stochastic Frontier Analysis [5][6][7], and the Bayesian Networks [1]. Contributions have also discussed how the structure of the health and social care system may affect efficiency and quality of care in nursing homes, with particular emphasis on the role of competition [8,9].…”

Section: Introductionmentioning

confidence: 99%

Efficiency and quality of care in nursing homes: an Italian case study

Garavaglia

Lettieri

Agasisti

et al. 2010

Health Care Manag Sci

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This study investigates efficiency and quality of care in nursing homes. By means of Data Envelopment Analysis (DEA), the efficiency of 40 nursing homes that deliver their services in the north-western area of the Lombardy Region was assessed over a 3-year period (2005-2007). Lombardy is a very peculiar setting, since it is the only Region in Italy where the healthcare industry is organised as a quasi-market, in which the public authority buys health and nursing services from independent providers-establishing a reimbursement system for this purpose. The analysis is conducted by generating bootstrapped DEA efficiency scores for each nursing home (stage one), then regressing those scores on explanatory variables (stage two). Our DEA model employed two input (i.e. costs for health and nursing services and costs for residential services) and three output variables (case mix, extra nursing hours and residential charges). In the second-stage analysis, Tobit regressions and the Kruskall-Wallis tests of hypothesis to the efficiency scores were applied to define what are the factors that affect efficiency: (a) the ownership (private nursing houses outperform their public counterparts); and (b) the capability to implement strategies for labour cost and nursing costs containment, since the efficiency heavily depends upon the alignment of the costs to the public reimbursement system. Lastly, even though the public institutions are less efficient than the private ones, the results suggest that public nursing homes are moving towards their private counterparts, and thus competition is benefiting efficiency.

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“…More recently Zhang et al (2008) The authors capture quality di¤erences by weighting the output with a score calculated using the number of de…ciency citations.…”

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

confidence: 99%

“…Chen and Shea, 2002;Norton, 1992;Zhang et al, 2008), there is little empirical evidence in Europe. A number of studies have been published on the impact of PPS in the hospital sector in di¤erent European countries, for instance Finland (Linna, 2000), Norway (Biorn et al, 2006), and Portugal (Dismuke and Sena, 1999).…”

Section: Introductionmentioning

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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Has the Medicare Prospective Payment System Led to Increased Nursing Home Efficiency?

Cited by 32 publications

References 36 publications

Explaining the efficiency of local health departments in the U.S.: an exploratory analysis

Explaining the efficiency of local health departments in the U.S.: an exploratory analysis

Efficiency and quality of care in nursing homes: an Italian case study

Implications of global budget payment system on nursing home costs

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