S. F. Lu, Konstantinos Serfes, G. Wedig, Bingxiao Wu
Competition plays an ambiguous role in nursing home markets where public and private payers coexist. Using U.S. nursing home data with a wide range of market structures, we find a U-shaped relationship between competition and service quality when nursing homes serve a mix of public and private segments, and a monotonically increasing relationship when nursing homes mostly serve the public, price-regulated, segment. The outcomes can be explained by the interplay of two opposing effects of competition: the reputation-building effect, whereby competing firms choose high quality to build a good reputation, and the rent-extraction effect, whereby competition hinders investment for quality improvements by lowering price premia. These observations are consistent with a repeated game model that incorporates public and private-payer segments. This paper was accepted by Stefan Scholtes, healthcare management.
{"title":"Does Competition Improve Service Quality? The Case of Nursing Homes Where Public and Private Payers Coexist","authors":"S. F. Lu, Konstantinos Serfes, G. Wedig, Bingxiao Wu","doi":"10.2139/ssrn.2963566","DOIUrl":"https://doi.org/10.2139/ssrn.2963566","url":null,"abstract":"Competition plays an ambiguous role in nursing home markets where public and private payers coexist. Using U.S. nursing home data with a wide range of market structures, we find a U-shaped relationship between competition and service quality when nursing homes serve a mix of public and private segments, and a monotonically increasing relationship when nursing homes mostly serve the public, price-regulated, segment. The outcomes can be explained by the interplay of two opposing effects of competition: the reputation-building effect, whereby competing firms choose high quality to build a good reputation, and the rent-extraction effect, whereby competition hinders investment for quality improvements by lowering price premia. These observations are consistent with a repeated game model that incorporates public and private-payer segments. This paper was accepted by Stefan Scholtes, healthcare management.","PeriodicalId":117887,"journal":{"name":"NursingRN: Long-Term Care (Sub-Topic)","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124476826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: Informal care substitutes for or postpones formal long-term care (LTC) use, especially in the Netherlands, where informal care supply affects eligibility for public LTC. The effect of potential informal care supply within the household has received less attention. We examine the role of spouse’s physical ability to provide informal care in explaining LTC use and transitions.Method: We used Dutch respondents from waves 1 and 2 of the Survey of Health, Ageing and Retirement in Europe. A mixed multinomial logit regression is used to model the choice between no LTC use, informal LTC use only, and formal LTC use. Transitions into formal care use are modeled with a logit regression.Results: Spouse ability affects LTC use but living alone remains important after controlling for spouse ability. Other important determinants of use are having a child , age, disability and health status. Transitions are explained by informal care supply and changes therein, health and disability and the respondent’s age. Discussion: Spouse ability to provide informal care reduces use of formal LTC, which implies that future compression of morbidity/disability and its impact would lower demand for LTC, directly and through increased spouse ability to provide informal care.
{"title":"The Influence of Spouse Ability to Provide Informal Care on Long-Term Care Use","authors":"P. Bakx, Claudine de Meijer","doi":"10.2139/ssrn.2407926","DOIUrl":"https://doi.org/10.2139/ssrn.2407926","url":null,"abstract":"Objective: Informal care substitutes for or postpones formal long-term care (LTC) use, especially in the Netherlands, where informal care supply affects eligibility for public LTC. The effect of potential informal care supply within the household has received less attention. We examine the role of spouse’s physical ability to provide informal care in explaining LTC use and transitions.Method: We used Dutch respondents from waves 1 and 2 of the Survey of Health, Ageing and Retirement in Europe. A mixed multinomial logit regression is used to model the choice between no LTC use, informal LTC use only, and formal LTC use. Transitions into formal care use are modeled with a logit regression.Results: Spouse ability affects LTC use but living alone remains important after controlling for spouse ability. Other important determinants of use are having a child , age, disability and health status. Transitions are explained by informal care supply and changes therein, health and disability and the respondent’s age. Discussion: Spouse ability to provide informal care reduces use of formal LTC, which implies that future compression of morbidity/disability and its impact would lower demand for LTC, directly and through increased spouse ability to provide informal care.","PeriodicalId":117887,"journal":{"name":"NursingRN: Long-Term Care (Sub-Topic)","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115459104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This paper examines how inability to perform activities of daily living relates to the risk of nursing home admission over older adults' life courses. Using longitudinal data on persons over age 50 from the Health and Retirement Study, we show that aging one year boosts the probability of having two or more disabilities by 9 to 12 percent in a multivariate logistic model. Moreover, at least three-fifths of all 65-year-old men and three-quarters of women will experience disability levels during their remaining lifetimes severe enough to trigger nursing home admission. Our analysis also suggests that certain types of disability are more important than others in predicting nursing home admittance and use, which has implications for the design and benefits triggers for long-term care insurance programs.
{"title":"Functional Disabilities and Nursing Home Admittance","authors":"Joelle H. Fong, Benedict S. K. Koh, O. Mitchell","doi":"10.2139/SSRN.2157548","DOIUrl":"https://doi.org/10.2139/SSRN.2157548","url":null,"abstract":"This paper examines how inability to perform activities of daily living relates to the risk of nursing home admission over older adults' life courses. Using longitudinal data on persons over age 50 from the Health and Retirement Study, we show that aging one year boosts the probability of having two or more disabilities by 9 to 12 percent in a multivariate logistic model. Moreover, at least three-fifths of all 65-year-old men and three-quarters of women will experience disability levels during their remaining lifetimes severe enough to trigger nursing home admission. Our analysis also suggests that certain types of disability are more important than others in predicting nursing home admittance and use, which has implications for the design and benefits triggers for long-term care insurance programs.","PeriodicalId":117887,"journal":{"name":"NursingRN: Long-Term Care (Sub-Topic)","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129813383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study incorporates market-level fixed effects into an analysis of panel data from Wisconsin to assess whether competitor market share influences choices of price and quality at for-profit and nonprofit nursing homes. The measured competitive effects are quite small, both between firms of the same ownership type and between firms of different types. A distinction is made between incumbent expansion (contraction) and entry (exit). Entering and exiting nursing homes engage in significantly different conduct than do incumbents, with entering nonprofits producing higher quality at lower prices than incumbents of either type, and exiting for-profits producing lower quality.
{"title":"Market Structure and Cross-Sector Competitive Effects in Wisconsin Nursing Homes, 1992-2002","authors":"Jeffrey P. Ballou","doi":"10.2139/ssrn.1507980","DOIUrl":"https://doi.org/10.2139/ssrn.1507980","url":null,"abstract":"This study incorporates market-level fixed effects into an analysis of panel data from Wisconsin to assess whether competitor market share influences choices of price and quality at for-profit and nonprofit nursing homes. The measured competitive effects are quite small, both between firms of the same ownership type and between firms of different types. A distinction is made between incumbent expansion (contraction) and entry (exit). Entering and exiting nursing homes engage in significantly different conduct than do incumbents, with entering nonprofits producing higher quality at lower prices than incumbents of either type, and exiting for-profits producing lower quality.","PeriodicalId":117887,"journal":{"name":"NursingRN: Long-Term Care (Sub-Topic)","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2007-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125655107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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