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Bach-Mortensen A, Goodair B, Degli Esposti M. Involuntary closures of for-profit care homes in England by the Care Quality Commission. THE LANCET. HEALTHY LONGEVITY 2024; 5:e297-e302. [PMID: 38490234 DOI: 10.1016/s2666-7568(24)00008-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/10/2024] [Accepted: 01/17/2024] [Indexed: 03/17/2024] Open
Abstract
Adult social care services in England are struggling, and sometimes failing, to supply the quality of care deserved by the most vulnerable people in society. The Care Quality Commission (CQC) is responsible for protecting the recipients of this crucial public service. Their strongest enforcement is the ability to cancel the registration-the legal right to operate-of a health or social care provider. Using novel data from the CQC, we show that the proportion of care home closures due to CQC enforcements, relative to all closures, is increasing. Since 2011, 816 care homes (representing 19 918 registered beds) have been involuntarily closed by the CQC. Our results show that effectively all involuntary closures (804/816) occurred in for-profit care homes. This data emphasises the need for a comprehensive assessment of the impact of for-profit provision on the quality and sustainability of adult social care in England.
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Affiliation(s)
- Anders Bach-Mortensen
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK; Department of Social Sciences and Business, Roskilde University, Roskilde, Denmark.
| | - Benjamin Goodair
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
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2
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Allan S, Vadean F. The Impact of Wages on Care Home Quality in England. THE GERONTOLOGIST 2023; 63:1428-1436. [PMID: 36964753 PMCID: PMC10581380 DOI: 10.1093/geront/gnad032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND AND OBJECTIVES In many countries, a large proportion of long-term care staff are paid at, or near, minimum wage, leading to concerns of negative effects on care outcomes. This study analyzed the effect of staff wages on care home quality ratings in England. RESEARCH DESIGN AND METHODS A national staffing database of long-term care providers was matched with local-area information on needs and supply to construct a 3-year panel (2016-2018) of English care home observations. Using multiple imputation methods to address missing data provided a data set of 12,055 observations of 5,556 care facilities (both residential and nursing homes). We analyzed the effect of the facility-level average hourly wage of care staff on national regulator quality ratings. A measure of the impact of exogenous changes in the national minimum wage on care facilities was used as an instrument for wage. RESULTS We find that wages positively affect care home quality ratings. Other things equal, a 10% increase in the average hourly wage of direct care workers would lead to a 7.1% increase in the likelihood that a care home will have a high-quality rating. The wage effect on quality was significant when controlling for staff skill mix, measured as the share of registered nurses in nursing home staff. DISCUSSION AND IMPLICATIONS This study provides important evidence of the positive impact that staff pay can have on the quality of long-term care. Our finding has important implications for appropriate levels of pay and the funding of long-term care.
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Affiliation(s)
- Stephen Allan
- Personal Social Services Research Unit (PSSRU), University of Kent, Canterbury, UK
| | - Florin Vadean
- Personal Social Services Research Unit (PSSRU), University of Kent, Canterbury, UK
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3
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van Eijkel R, Kattenberg M, van der Torre A. Pricing behavior in long term care markets: evidence from provider-level data for home help services. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2023; 23:59-83. [PMID: 35622262 DOI: 10.1007/s10754-022-09334-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 04/26/2022] [Indexed: 06/15/2023]
Abstract
Exploiting a rich data set on the Dutch market for home help services, we find that larger providers obtain a higher price than do small providers. However, compared to other studies on market power in care markets this price difference is considered small to moderate. Our identification strategy relies on the exogenous variation in market shares in January'07, the very first month after home help was decentralized to municipalities. Zooming in on our main outcome, we obtain that the small but significant effect of market size on price is merely driven by the pricing behavior of for-profit providers.
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Affiliation(s)
| | - Mark Kattenberg
- CPB Netherlands Bureau for Economic Policy Analysis, The Hague, The Netherlands
| | - Ab van der Torre
- The Netherlands Institute for Social Research, The Hague, The Netherlands
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4
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Patwardhan S, Sutton M, Morciano M. Effects of chain ownership and private equity financing on quality in the English care home sector: retrospective observational study. Age Ageing 2022; 51:6936404. [PMID: 36571782 PMCID: PMC9792077 DOI: 10.1093/ageing/afac222] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/21/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND the structure of care homes markets in England is changing with the emergence of for-profit homes organised in chains and financed by private equity. Previous literature shows for-profit homes were rated lower quality than not-for-profit homes when inspected by the national regulator, but has not considered new forms of financing. OBJECTIVES to examine whether financing and organisation of care homes is associated with regulator assessments of quality. METHODS retrospective observational study of the Care Quality Commission's ratings of 10,803 care homes providing services to older people as of January 2020. We used generalised ordered logistic models to assess whether ratings differed between not-for-profit and for-profit homes categorised into three groups: (i) chained ownership, financed by private equity; (ii) chained ownership, not financed by private equity and (iii) independent ownership. We compared Overall and domain (caring, effective, responsive, safe, well-led) ratings adjusted for care home size, age and location. RESULTS all three for-profit ownership types had lower average overall ratings than not-for-profit homes, especially independent (6.8% points (p.p.) more likely rated as 'Requires Improvement/Inadequate', 95% CI: 4.7-8.9) and private equity chains (6.6 p.p. more likely rated as 'Requires Improvement/Inadequate', 95% CI: 2.9-10.2). Independent homes scored better than private equity chains in the safe, effective and responsive domains but worst in the well-led domain. DISCUSSION private equity financing and independent for-profit ownership are associated with lower quality. The consequences of the changing care homes market structure for quality of services should be monitored.
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Affiliation(s)
- Sharvari Patwardhan
- Health Organization, Policy and Economics (HOPE) research group, School of Health Science, Oxford Road, M13 9PL, Manchester, UK
| | - Matthew Sutton
- Health Organization, Policy and Economics (HOPE) research group, School of Health Science, Oxford Road, M13 9PL, Manchester, UK
| | - Marcello Morciano
- Address correspondence to: Morciano Marcello, The University of Manchester, UK.
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5
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Simmons C, Rodrigues R, Szebehely M. Working conditions in the long-term care sector: A comparative study of migrant and native workers in Austria and Sweden. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e2191-e2202. [PMID: 34825423 DOI: 10.1111/hsc.13657] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 09/22/2021] [Accepted: 11/05/2021] [Indexed: 06/13/2023]
Abstract
Increased demand for long-term care (LTC) services alongside precarious working conditions has resulted in labour shortages in the LTC sector, which has led to an increasing share of workers of migrant origin filling these jobs. Previous research on migrant care workers has also highlighted the seeming gap in working conditions relative to native workers. However, lack of disaggregated data on migrant and native care workers, alongside single-case studies, may have concealed potential disadvantages faced by certain groups and insufficiently accounted for differences in migration regimes and organisation of LTC sectors. To address these gaps, we carried out a comparative study on various working conditions of migrant and native LTC workers in Austria and Sweden. Using the international Nordcare survey on care sector working conditions, carried out in Austria in 2017 (n = 792) and in Sweden in 2015 (n = 708), we employed t-tests and multivariate logistic regressions to compare the working conditions of migrant and native carers in home and residential care in each country. We found that worse working conditions in Sweden compared to Austria may be explained by differences in training requirements of the LTC workforce and the relatively large for-profit private sector. Country of origin also plays a paramount role in the differences in working conditions experienced by migrants compared to native care workers, with non-European migrants being more likely to face a number of precarious working conditions. Our findings highlight the need to continue addressing precarious working conditions across the sector, particularly during the COVID-19 pandemic where poor working conditions have been linked to increased COVID-related deaths in nursing homes. Our findings also emphasise the importance of policies that consider the various challenges experienced by different migrant groups in the LTC sector, who may particularly be at risk of presenteeism during the COVID-19 pandemic.
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Affiliation(s)
- Cassandra Simmons
- European Centre for Social Welfare Policy & Research, Vienna, Austria
| | - Ricardo Rodrigues
- European Centre for Social Welfare Policy & Research, Vienna, Austria
| | - Marta Szebehely
- Department of Social Work, Stockholm University, Stockholm, Sweden
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6
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Heger D, Herr A, Mensen A. Paying for the view? How nursing home prices affect certified staffing ratios. HEALTH ECONOMICS 2022; 31:1618-1632. [PMID: 35581684 DOI: 10.1002/hec.4532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/04/2022] [Accepted: 04/25/2022] [Indexed: 06/15/2023]
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.
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Affiliation(s)
- Dörte Heger
- RWI - Leibniz Institute for Economic Research, Essen, Germany
- Leibniz Science Campus Ruhr, Essen, Germany
| | - Annika Herr
- Institute of Health Economics and CHERH, Leibniz University Hannover, Hannover, Germany
- CINCH - Health Economics Research Center, Essen, Germany
| | - Anne Mensen
- RWI - Leibniz Institute for Economic Research, Essen, Germany
- Leibniz Science Campus Ruhr, Essen, Germany
- Ruhr-University Bochum, Bochum, Germany
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7
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Pitkänen V. Competition and efficiency in repeated procurements: Lessons from the Finnish rehabilitation markets. HEALTH ECONOMICS 2022; 31:820-835. [PMID: 35187744 PMCID: PMC9304294 DOI: 10.1002/hec.4485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 01/11/2022] [Accepted: 02/05/2022] [Indexed: 06/14/2023]
Abstract
Inefficient practices and lack of competition are common problems in public procurements. In this study, I examine the effects of a procurement practice reform in the Finnish rehabilitation markets where providers are acquired in a repeated manner through competitive bidding scoring auctions. Until recently, the largest public procurer did not use any systematic criteria for accepting providers, and only a few providers did not receive a contract. After the reform, providers were systematically accepted based on their capacity and the local demand. I analyze the effects of the reform on prices in physio, speech and occupational therapy services with data that covers five subsequent procurements. I use the pre-reform differences in local competition within the markets in a difference-in-differences setting. The descriptive evidence shows that the reform slowed down the rapid increase of prices in all three services. The regression analysis indicates that effects are strongest in the most competitive local physiotherapy markets. This suggests that increasing entry and competition in the less competitive services and local markets would benefit the public procurer.
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Affiliation(s)
- Visa Pitkänen
- Research DepartmentSocial Insurance Institution of FinlandHelsinkiFinland
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8
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A critique of the marketisation of long-term residential and nursing home care. THE LANCET. HEALTHY LONGEVITY 2022; 3:e298-e306. [PMID: 36098302 DOI: 10.1016/s2666-7568(22)00040-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 12/24/2022] Open
Abstract
Long-term care systems across countries within the Organisation for Economic Co-operation and Development have undergone a progressive marketisation and financialisation in recent decades, characterised by the embedding of neoliberal market values such as competition, consumer choice, and the profit motive. In this Personal View, we argue that these make poor guiding principles for the care sector, identifying the dysfunctional dynamics that arise as a result, and reflecting on the clinical implications of each, with a focus on facility-based care. We outline why providers can scarcely respond to competitive forces without compromising care quality. We explain why the promotion of consumer choice cannot effectively motivate improvements to quality of care. And we explore how privatisation opens the door to predatory financial practices. We conclude by considering how far proposals for reform can take us, ultimately arguing for a rejection of neoliberal market ideology, and calling for sector-wide discussions about what principles would be more fitting for a caring economy.
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Towers AM, Smith N, Allan S, Vadean F, Collins G, Rand S, Bostock J, Ramsbottom H, Forder J, Lanza S, Cassell J. Care home residents’ quality of life and its association with CQC ratings and workforce issues: the MiCareHQ mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2021. [DOI: 10.3310/hsdr09190] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background
Care home staff have a critical bearing on quality. The staff employed, the training they receive and how well they identify and manage residents’ needs are likely to influence outcomes. The Care Act 2014 (Great Britain. The Care Act 2014. London: The Stationery Office; 2014) requires services to improve ‘well-being’, but many residents cannot self-report and are at risk of exclusion from giving their views. The Adult Social Care Outcomes Toolkit enables social care-related quality of life to be measured using a mixed-methods approach. There is currently no equivalent way of measuring aspects of residents’ health-related quality of life. We developed new tools for measuring pain, anxiety and depression using a mixed-methods approach. We also explored the relationship between care home quality, residents’ outcomes, and the skill mix and employment conditions of the workforce who support them.
Objectives
The objectives were to develop and test measures of pain, anxiety and depression for residents unable to self-report; to assess the extent to which regulator quality ratings reflect residents’ care-related quality of life; and to assess the relationship between aspects of the staffing of care homes and the quality of care homes.
Design
This was a mixed-methods study.
Setting
The setting was care homes for older adults in England.
Participants
Care home residents participated.
Results
Three measures of pain, anxiety and low mood were developed and tested, using a mixed-methods approach, with 182 care home residents in 20 care homes (nursing and residential). Psychometric testing found that the measures had good construct validity. The mixed-methods approach was both feasible and necessary with this population, as the majority of residents could not self-report. Using a combined data set (n = 475 residents in 54 homes) from this study and the Measuring Outcomes in Care Homes study (Towers AM, Palmer S, Smith N, Collins G, Allan S. A cross-sectional study exploring the relationship between regulator quality ratings and care home residents’ quality of life in England. Health Qual Life Outcomes 2019;17:22) we found a significant positive association between residents’ social care-related quality of life and regulator (i.e. Care Quality Commission) quality ratings. Multivariate regression revealed that homes rated ‘good/outstanding’ are associated with a 12% improvement in mean current social care-related quality of life among residents who have higher levels of dependency. Secondary data analysis of a large, national sample of care homes over time assessed the impact of staffing and employment conditions on Care Quality Commission quality ratings. Higher wages and a higher prevalence of training in both dementia and dignity-/person-centred care were positively associated with care quality, whereas high staff turnover and job vacancy rates had a significant negative association. A 10% increase in the average care worker wage increased the likelihood of a ‘good/outstanding’ rating by 7%.
Limitations
No care homes rated as inadequate were recruited to the study.
Conclusions
The most dependent residents gain the most from homes rated ‘good/outstanding’. However, measuring the needs and outcomes of these residents is challenging, as many cannot self-report. A mixed-methods approach can reduce methodological exclusion and an over-reliance on proxies. Improving working conditions and reducing staff turnover may be associated with better outcomes for residents.
Future work
Further work is required to explore the relationship between pain, anxiety and low mood and other indicators of care homes quality and to examine the relationship between wages, training and social care outcomes.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 19. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Ann-Marie Towers
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Nick Smith
- Personal Social Services Research Unit, University of Kent, Canterbury, UK
| | - Stephen Allan
- Personal Social Services Research Unit, University of Kent, Canterbury, UK
| | - Florin Vadean
- Personal Social Services Research Unit, University of Kent, Canterbury, UK
| | - Grace Collins
- Personal Social Services Research Unit, University of Kent, Canterbury, UK
| | - Stacey Rand
- Personal Social Services Research Unit, University of Kent, Canterbury, UK
| | | | | | - Julien Forder
- Personal Social Services Research Unit, University of Kent, Canterbury, UK
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10
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Espuny Pujol F, Hancock R, Hviid M, Morciano M, Pudney S. Market concentration, supply, quality and prices paid by local authorities in the English care home market. HEALTH ECONOMICS 2021; 30:1886-1909. [PMID: 33966316 DOI: 10.1002/hec.4286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 03/13/2021] [Accepted: 04/23/2021] [Indexed: 06/12/2023]
Abstract
We investigate the impact of exogenous local conditions which favor high market concentration on supply, price and quality in local markets for care homes for older people in England. We extend the existing literature in: (i) considering supply capacity as a market outcome alongside price and quality; (ii) taking account of the chain structure of care home supply and differences between the nursing home and residential care home sectors; (iii) using an econometric approach based on reduced form relationships that treats market concentration as a jointly determined outcome of a complex market. We find that areas susceptible to a high degree of market concentration tend to have greatly restricted supply of care home places and (to a lesser extent) a higher average public cost, than areas susceptible to low degree of market concentration. There is no significant evidence that conditions favoring high market concentration affect average care home quality.
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Affiliation(s)
- Ferran Espuny Pujol
- Clinical Operational Research Unit, University College London, London, UK
- Health Economics Group, University of East Anglia, Norwich, UK
| | - Ruth Hancock
- Health Economics Group, University of East Anglia, Norwich, UK
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Morten Hviid
- Centre for Competition Policy, University of East Anglia, Norwich, UK
| | - Marcello Morciano
- Health Organisation, Policy and Economics, University of Manchester, Manchester, UK
| | - Stephen Pudney
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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11
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Pitkänen V, Linnosmaa I. Choice, quality and patients' experience: evidence from a Finnish physiotherapy service. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2021; 21:229-245. [PMID: 33469804 PMCID: PMC8192355 DOI: 10.1007/s10754-020-09293-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 12/18/2020] [Indexed: 06/12/2023]
Abstract
We study the relationship between patient choices and provider quality in a rehabilitation service for disabled patients who receive the service frequently but do not have access to quality information. Previous research has found a positive relationship between patient choices and provider quality in health services that patients typically do not have previous experience or use frequently. We contribute by examining choices of new patients and experienced patients who were either forced to switch or actively switched their provider. In the analysis, we combine register data on patients' choices and switches with provider quality data from a competitive bidding, and estimate conditional logit choice models. The results show that all patients prefer high-quality providers within short distances. We find that the willingness to travel for quality is highest among new patients and active switchers. These results suggest that new patients and active switchers compare different alternatives more thoroughly, whereas forced switchers choose their new provider in limited time leading into poorer choices.
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Affiliation(s)
- Visa Pitkänen
- Research Department, Social Insurance Institution of Finland, P.O. Box 450, 00056, Helsinki, Finland.
| | - Ismo Linnosmaa
- Department of Health and Social Management, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland
- Centre for Health and Social Economics, National Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland
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12
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Yang O, Yong J, Scott A. Nursing Home Competition, Prices and Quality: A Scoping Review and Policy Lessons. THE GERONTOLOGIST 2021; 62:e384-e401. [PMID: 33851988 DOI: 10.1093/geront/gnab050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES In recent years, countries have increasingly relied on markets to improve efficiency, contain costs, and maintain quality in aged care. Under the right conditions, competition can spur providers to compete by offering better prices and higher quality of services. However, in aged care, market failures can be extensive. Information about prices and quality may not be readily available and search costs can be high. This study undertakes a scoping review on competition in the nursing home sector, with an emphasis on empirical evidence in relation to how competition affects prices and quality of care. RESEARCH DESIGN AND METHODS Online databases were used to identify studies published in English language between 1988 and 2020. A total of 50 studies covering nine countries are reviewed. RESULTS The review finds conflicting evidence on the relationship between competition and quality. Some studies find greater competition leading to higher quality, others find the opposite. Institutional features such as the presence of binding supply restrictions on nursing homes and public reporting of quality information are important considerations. Most studies find greater competition tends to result in lower prices, although the effect is small. DISCUSSION AND IMPLICATIONS The literature offers several key policy lessons, including the relationship between supply restrictions and quality which has implications on whether increasing subsidies can result in higher quality and the importance of price transparency and public reporting of quality.
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Affiliation(s)
- Ou Yang
- Melbourne Institute: Applied Economic & Social Research, The University of Melbourne, Parkville, Victoria, Australia
| | - Jongsay Yong
- Melbourne Institute: Applied Economic & Social Research, The University of Melbourne, Parkville, Victoria, Australia
| | - Anthony Scott
- Melbourne Institute: Applied Economic & Social Research, The University of Melbourne, Parkville, Victoria, Australia
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Abstract
This paper examines the association between workforce retention and related staffing measures and the quality of English care homes using a national database of social care providers' staffing. The analysis finds significant correlations between quality and the levels of staffing vacancies and retention of both residential and nursing homes, but no association was found between quality and the use of temporary contract workers nor the resident to staff ratio. Only for staff vacancy rates was there a significant difference in the size of these relationships between types of home. The findings suggest that quality could change for the average care home with a relatively small alteration in staffing circumstance. Long-term care is a labor-intensive industry and many countries face relatively high levels of staff turnover and job vacancy rates. These findings are therefore of interest for policy internationally and for England in particular, where the development of social care recruitment and retention strategies are ongoing.
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Affiliation(s)
- Stephen Allan
- Research Fellow, PSSRU, University of Kent, Canterbury, UK
| | - Florin Vadean
- Research Fellow, PSSRU, University of Kent, Canterbury, UK
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14
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Yeh SC, Tsay SF, Wang WC, Lo YY, Shi HY. Determinants of Successful Nursing Home Accreditation. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2021; 58:469580211059998. [PMID: 34812691 PMCID: PMC8640283 DOI: 10.1177/00469580211059998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This study examined the factors associated with better accreditation outcomes among nursing homes. METHOD A total of 538 nursing homes in Taiwan were included in this study. Measures included accreditation scores, external factors (household income, Herfindahl-Hirschman Index, old-age dependency ratio, population density, and number of older adult households), organizational factors (hospital-based status, chain-affiliated status, occupancy rate, the number of registered nurses or nurse aides per bed, and bed size), and internal factors (accountability, deficiencies, person-centered care, nursing skills, quality control, and integrated care). RESULTS Bed size, hospital-based status, accountability, deficiencies, person-centered care, nursing skills, quality control, and integrated care were found to predict accreditation. CONCLUSION Among all variables in this study, the quality indicators contributed to the most variation, followed by organizational factors. External environmental factors played a minor role in predicting accreditation. A focus on quality of care would benefit not only the residents of a nursing home but also facilitate its accreditation.
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Affiliation(s)
- Shu-Chuan Yeh
- Institute of Health Care Management & Department of Business Management, College of Management, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Shwu-Feng Tsay
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen Chun Wang
- Director-General, Department of Nursing and Health Care, Ministry of Health and Welfare, Taiwan
| | - Ying-Ying Lo
- Adjunct Associate Professor, Department of Health Services Administration, College of Public Health, China Medical University, Taiwan
| | - Hon-Yi Shi
- Department of Business Management, College of Management, National Sun Yat-sen University, Kaohsiung, Taiwan
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15
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Raes S, Vandepitte S, De Smedt D, Wynendaele H, DeJonghe Y, Trybou J. The relationship of nursing home price and quality of life. BMC Health Serv Res 2020; 20:987. [PMID: 33161901 PMCID: PMC7650205 DOI: 10.1186/s12913-020-05833-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 10/20/2020] [Indexed: 11/21/2022] Open
Abstract
Background Knowledge about the relationship between the residents’ Quality of Life (QOL) and the nursing home price is currently lacking. Therefore, this study investigates the relationship between 11 dimensions of QOL and nursing homes price in Flemish nursing homes. Methods The data used in this cross-sectional study were collected by the Flemish government from years 2014 to 2017 and originates from 659 Flemish nursing homes. From 2014 to 2016, data on the QOL of 21,756 residents was assessed with the InterRAI instrument. This instrument contains 11 QOL dimensions. Multiple linear regression analyses were conducted to examine the research question. Results The multiple linear regressions indicated that a 10 euro increase in the daily nursing home price is associated with a significant decrease (P < 0.001) of 0.1 in 5 dimensions of QOL (access to services, comfort and environment, food and meals, respect, and safety and security). Hence, our results indicate that the association between price and QOL is very small. When conducting a subgroup analysis based on ownership type, the earlier found results remained only statistically significant for private nursing homes. Conclusion Our findings show that nursing home price is of limited importance with respect to resident QOL. Contrary to popular belief, our study demonstrates a limited negative effect of price on QOL. Further research that includes other indicators of QOL is needed to allow policymakers and nursing home managers to improve nursing home residents’ QOL.
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Affiliation(s)
- Sarah Raes
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
| | - Sophie Vandepitte
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Delphine De Smedt
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Herlinde Wynendaele
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Yannai DeJonghe
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Jeroen Trybou
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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Pitkänen V, Jauhiainen S, Linnosmaa I. Low risk, high reward? Repeated competitive biddings with multiple winners in health care. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2020; 21:483-500. [PMID: 31902025 PMCID: PMC7214509 DOI: 10.1007/s10198-019-01143-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 12/03/2019] [Indexed: 06/10/2023]
Abstract
We study physiotherapy providers' prices in repeated competitive biddings where multiple providers are accepted in geographical districts. Historically, only very few districts have rejected any providers. We show that this practice increased prices and analyze the effects the risk of rejection has on prices. Our data are derived from three subsequent competitive biddings. The results show that rejecting at least one provider decreased prices by more than 5% in the next procurement round. The results also indicate that providers have learned to calculate their optimal bids, which has also increased prices. Further, we perform counterfactual policy analysis of a capacity-rule of acceptance. The analysis shows that implementing a systematic acceptance rule results in a trade-off between direct cost savings and service continuity at patients' usual providers.
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Affiliation(s)
- Visa Pitkänen
- Research Department, Social Insurance Institution of Finland, P.O. Box 450, 00056, Helsinki, Finland.
| | - Signe Jauhiainen
- Research Department, Social Insurance Institution of Finland, P.O. Box 450, 00056, Helsinki, Finland
| | - Ismo Linnosmaa
- Department of Health and Social Management, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland
- Centre for Health and Social Economics, National Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland
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17
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Exploring differences between private and public prices in the English care homes market. HEALTH ECONOMICS POLICY AND LAW 2020; 16:138-153. [DOI: 10.1017/s1744133120000018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractThis work quantitatively assesses the potential reasons behind the difference in prices paid by care home residents in England. Evidence suggests that the price paid by private payers is higher than that paid for publicly supported residents, and this is often attributed to the market power wielded by local authorities as the dominant purchaser in local markets. Estimations of private prices at the local authority level are used to assess the difference in price paid between private and public prices, the fees gap, using data from 2008 to 2010. Controlling for local area and average care home characteristics, the results indicate that both care home and local authority market power play a role in the price determination of the market.
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Towers AM, Palmer S, Smith N, Collins G, Allan S. A cross-sectional study exploring the relationship between regulator quality ratings and care home residents' quality of life in England. Health Qual Life Outcomes 2019; 17:22. [PMID: 30704482 PMCID: PMC6357453 DOI: 10.1186/s12955-019-1093-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 01/15/2019] [Indexed: 08/19/2023] Open
Abstract
Background The quality of life of people receiving health and social care is an important indicator of service quality, but the relationship between patient experience and outcomes and regulator quality ratings in England is unknown. In 2013, the health and social care regulator in England, the Care Quality Commission (CQC), introduced a new ratings system and by February 2017, all social care services were inspected and awarded new quality ratings (outstanding, good, requires improvement and inadequate). This study aimed to explore whether quality ratings were associated with residents’ quality of life, controlling for confounding variables. Methods We conducted a nested, cross-sectional study, collecting social care-related quality of life (SCRQoL) data for 293 older care home residents in 34 care homes (20 nursing and 14 residential) in the South East of England. CQC ratings and other resident and home-level variables were also collected for the analysis. Multilevel modelling explored whether residents’ social care-related quality of life (SCRQoL) was associated with regulator ratings, controlling for confounding variables. Results Outstanding and good homes were collapsed into one category and compared with homes requiring improvement. Nationally, only 2 % of care homes for older people are rated as inadequate and it was not possible to capture sufficient numbers for the analysis. We recruited one but it was re-inspected during the fieldwork period and its rating changed to requires improvement. The random intercept multilevel model, which accounted for 16.93% of the differences in SCRQoL within homes and 69.80% between, indicated that better SCRQoL was significantly associated with being female, better functioning, no dementia diagnosis, fewer communication difficulties, and living in a care home rated as outstanding/good by CQC. Size of home and registration category were not significant predictors. Conclusions This study found evidence that quality ratings are associated with residents’ SCRQoL. As well as aiming to improve quality and ensure minimum standards, quality ratings have the potential to inform user choice and help the public compare care homes based on quality. Future research to establish the generalisability and replicability of the results is required.
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Affiliation(s)
- Ann-Marie Towers
- Personal Social Services Research Unit (PSSRU), University of Kent, Canterbury, CT2 7NF, UK.
| | - Sinead Palmer
- Personal Social Services Research Unit (PSSRU), University of Kent, Canterbury, CT2 7NF, UK
| | - Nick Smith
- Personal Social Services Research Unit (PSSRU), University of Kent, Canterbury, CT2 7NF, UK
| | - Grace Collins
- Personal Social Services Research Unit (PSSRU), University of Kent, Canterbury, CT2 7NF, UK
| | - Stephen Allan
- Personal Social Services Research Unit (PSSRU), University of Kent, Canterbury, CT2 7NF, UK
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19
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Hasseler M. [Critical discussion on the current quality debate on long-term care-a plea for a systemic and empirical insight into the development and measurement of quality in long-term care]. Z Gerontol Geriatr 2018; 52:468-476. [PMID: 29943079 DOI: 10.1007/s00391-018-1420-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 06/09/2018] [Accepted: 06/14/2018] [Indexed: 10/28/2022]
Abstract
Against the background of the quality debates on long-term care and recurrent reform measures in politics on this topic, a critical discussion on the current state of quality development, testing and reporting in Germany is presented. In Germany, the linear model of Donabedian's structural, process and outcome quality is still used as a basis for quality issues in nursing care; however, international research suggests that multiple and mutually interacting factors influence nursing quality and that a more systematic and systemic perspective for the further development of nursing quality (especially of features, criteria and indicators of nursing quality) appears more appropriate. This article intends to open the perspective of the development, measurement and reporting of quality in nursing and to make a critical contribution for a systemic theory development as a relevant basis for future developments of quality evaluation programs and quality reporting systems in long-term care.
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Affiliation(s)
- Martina Hasseler
- Medizinische Fakultät, Abteilung Allgemeinmedizin & Versorgungsforschung, Universität Heidelberg, Im Neuenheimer Feld 130.3, Turm West, 69120, Heidelberg, Deutschland.
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20
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Croes RR, Krabbe-Alkemade YJFM, Mikkers MC. Competition and quality indicators in the health care sector: empirical evidence from the Dutch hospital sector. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2018; 19:5-19. [PMID: 28050682 PMCID: PMC5773634 DOI: 10.1007/s10198-016-0862-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 12/06/2016] [Indexed: 06/06/2023]
Abstract
There is much debate about the effect of competition in healthcare and especially the effect of competition on the quality of healthcare, although empirical evidence on this subject is mixed. The Netherlands provides an interesting case in this debate. The Dutch system could be characterized as a system involving managed competition and mandatory healthcare insurance. Information about the quality of care provided by hospitals has been publicly available since 2008. In this paper, we evaluate the relationship between quality scores for three diagnosis groups and the market power indicators of hospitals. We estimate the impact of competition on quality in an environment of liberalized pricing. For this research, we used unique price and production data relating to three diagnosis groups (cataract, adenoid and tonsils, bladder tumor) produced by Dutch hospitals in the period 2008-2011. We also used the quality indicators relating to these diagnosis groups. We reveal a negative relationship between market share and quality score for two of the three diagnosis groups studied, meaning that hospitals in competitive markets have better quality scores than those in concentrated markets. We therefore conclude that more competition is associated with higher quality scores.
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Affiliation(s)
- R. R. Croes
- NZa (Dutch Healthcare Authority) and Erasmus University Rotterdam, Rotterdam, The Netherlands
| | | | - M. C. Mikkers
- NZa (Dutch Healthcare Authority) and Tilburg University, Tilburg, The Netherlands
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21
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Pekola P, Linnosmaa I, Mikkola H. Does Competition Have an Effect on Price and Quality in Physiotherapy? HEALTH ECONOMICS 2017; 26:1278-1290. [PMID: 27619843 DOI: 10.1002/hec.3402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 05/30/2016] [Accepted: 07/19/2016] [Indexed: 06/06/2023]
Abstract
We estimate the effect of competition on quality and prices in physiotherapy organised and financed by the Social Insurance Institution of Finland for disabled individuals. Within the physiotherapy market, firms participate in competitive bidding, prices are determined by the market, services are free at the point of use and firms are allowed to react to patient choice only by enhancing quality. Firm-level data (n = 854) regarding quality and price were analysed. Using 2SLS estimation techniques, we analysed the relationship between quality and competition, and price and competition. Our study found that competition has a negative (yet weak) effect on quality. Prices on the other hand are not affected by competition. The result is likely caused by imperfect information, because it seems that the Social Insurance Institution of Finland has provided too little information for patients to make adequate choices about proper service providers. We argue that by publishing quality information, it is possible to ease the decision-making of patients and influence the quality strategies of firms active in the physiotherapy market. Moreover, we found that competition appeared as an exogenous variable in this study. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Piia Pekola
- Research Department, Social Insurance Institution of Finland, Helsinki, Finland
| | - Ismo Linnosmaa
- National Institute for Health and Welfare, Helsinki, Finland
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Abstract
ABSTRACTThe benefits of meaningful activity in later life are well documented. Studies show that being occupied contributes to both physical and mental health as well as quality of life. Research also suggests that activity may be beneficial to people residing in care homes, including people living with dementia. This paper presents findings from a study which used the Adult Social Care Outcomes Toolkit (ASCOT) to measure quality of life in six care homes located in the south-east of England. The study found, like previous ones, that care home residents’ days were characterised by a lack of activity. Drawing on observations, interviews and focus groups with residents and staff from these homes, this paper attempts to understand why care home residents do not engage in meaningful activities. We reject the idea that these low levels of activity are a natural part of the ageing process or that they can be explained by notions of resident choice. Instead, the findings point to both insufficient funding and working practices within care homes as more substantive explanations. These explanations inform a discussion of how the low levels of engagement in meaningful activity could be addressed and residents’ quality of life improved.
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23
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Yang W, Forder J, Nizalova O. Measuring the productivity of residential long-term care in England: methods for quality adjustment and regional comparison. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2017; 18:635-647. [PMID: 27422731 PMCID: PMC5438827 DOI: 10.1007/s10198-016-0816-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 06/23/2016] [Indexed: 06/06/2023]
Abstract
Productivity trend information is valuable in developing policy and for understanding changes in the 'value for money' of the care system. In this paper, we consider approaches to measuring productivity of adult social care (ASC), and particularly care home services. Productivity growth in the public sector is traditionally measured by comparing change in total output to change in total inputs, but has not accounted for changes in service quality and need. In this study, we propose a method to estimate 'quality adjusted' output based on indicators of the Adult Social Care Outcomes Toolkit (ASCOT), using data collected in the annual adult social care survey (ASCS). When combined with expenditure and activity data for 2010 to 2012, we found that this approach was feasible to implement with current data and that it altered the productivity results compared with non-adjusted productivity metrics. Overall, quality-adjusted productivity grew in most regions between 2010 and 2011 and remained unchanged for most regions from 2011 to 2012.
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Affiliation(s)
- Wei Yang
- Personal Social Services Research Unit, George Allen Wing, University of Kent, Kent, Canterbury, CT2 7NF UK
| | - Julien Forder
- Personal Social Services Research Unit, George Allen Wing, University of Kent, Kent, Canterbury, CT2 7NF UK
| | - Olena Nizalova
- Personal Social Services Research Unit, George Allen Wing, University of Kent, Kent, Canterbury, CT2 7NF UK
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24
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Barron DN, West E. The quasi-market for adult residential care in the UK: Do for-profit, not-for-profit or public sector residential care and nursing homes provide better quality care? Soc Sci Med 2017; 179:137-146. [DOI: 10.1016/j.socscimed.2017.02.037] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 01/07/2017] [Accepted: 02/24/2017] [Indexed: 11/30/2022]
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25
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Pekola P, Linnosmaa I, Mikkola H. Competition and quality in a physiotherapy market with fixed prices. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2017; 18:97-117. [PMID: 27037838 DOI: 10.1007/s10198-016-0792-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 03/10/2016] [Indexed: 06/05/2023]
Abstract
Our study focuses on competition and quality in physiotherapy organized and regulated by the Social Insurance Institution of Finland (Kela). We first derive a hypothesis with a theoretical model and then perform empirical analyses of the data. Within the physiotherapy market, prices are regulated by Kela, and after registration eligible firms are accepted to join a pool of firms from which patients choose service providers based on their individual preferences. By using 2SLS estimation techniques, we analyzed the relationship among quality, competition and regulated price. According to the results, competition has a statistically significant (yet weak) negative effect (p = 0.019) on quality. The outcome for quality is likely caused by imperfect information. It seems that Kela has provided too little information for patients about the quality of the service.
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Affiliation(s)
- Piia Pekola
- Social Insurance Institution of Finland, PL 450, 00101, Helsinki, Finland.
| | - Ismo Linnosmaa
- National Institute for Health and Welfare, PL 30, 00271, Helsinki, Finland
| | - Hennamari Mikkola
- Social Insurance Institution of Finland, PL 450, 00101, Helsinki, Finland
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26
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Herr A, Nguyen TV, Schmitz H. Public reporting and the quality of care of German nursing homes. Health Policy 2016; 120:1162-1170. [PMID: 27671099 DOI: 10.1016/j.healthpol.2016.09.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 07/25/2016] [Accepted: 09/05/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Since 2009, German nursing homes have been evaluated regularly by an external institution with quality report cards published online. We follow recent debates and argue that most of the information in the report cards does not reliably measure quality of care. However, a subset of up to seven measures does. Do these measures that reflect "risk factors" improve over time? METHOD Using a sample of more than 3000 German nursing homes with information on two waves, we assume that the introduction of public reporting is an exogenous institutional change and apply before-after-estimations to obtain estimates for the relation between public reporting and quality. RESULTS We find a significant improvement of the identified risk factors. Also, the two employed outcome quality indicators improve significantly. The improvements are driven by nursing homes with low quality in the first evaluation. CONCLUSION To the extent that this can be interpreted as evidence that public reporting positively affects the (reported) quality in nursing homes, policy makers should carefully choose indicators reflecting care-sensitive quality.
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Affiliation(s)
- Annika Herr
- Düsseldorf Institute for Competition Economics (DICE), Heinrich-Heine-University Düsseldorf, Universitätsstrasse 1, 40225 Düsseldorf, Germany; CINCH - Health Economics Research Center, Universität Duisburg-Essen Weststadttürme, Berliner Platz 6-8, 45127 Essen, Germany.
| | - Thu-Van Nguyen
- Düsseldorf Institute for Competition Economics (DICE), Heinrich-Heine-University Düsseldorf, Universitätsstrasse 1, 40225 Düsseldorf, Germany; CINCH - Health Economics Research Center, Universität Duisburg-Essen Weststadttürme, Berliner Platz 6-8, 45127 Essen, Germany.
| | - Hendrik Schmitz
- CINCH - Health Economics Research Center, Universität Duisburg-Essen Weststadttürme, Berliner Platz 6-8, 45127 Essen, Germany; University of Paderborn, Warburger Strasse 100, 33098 Paderborn, Germany; RWI, Hohenzollernstraße 1-3, 45128 Essen, Germany.
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27
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Zhao X. Competition, information, and quality: Evidence from nursing homes. JOURNAL OF HEALTH ECONOMICS 2016; 49:136-152. [PMID: 27423014 DOI: 10.1016/j.jhealeco.2016.05.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Revised: 05/17/2016] [Accepted: 05/21/2016] [Indexed: 06/06/2023]
Abstract
Economic theory suggests that competition and information can both be important for product quality, and yet evidence on how they may interact to affect quality is sparse. This paper estimates the impact of competition between nursing homes on their quality, and how this impact varies when consumers have better access to information. The effect of competition is identified using exogenous variation in the geographical proximity of nursing homes to their potential consumers. The change in information transparency is captured by the launch of the Five-Star Quality Rating System in 2009, which improved access to the quality information of nursing homes. We find that while the effect of competition on nursing home quality is generally rather limited, this effect becomes significantly stronger with increased information transparency. The results suggest that regulations on public quality reporting and on market structure are policy complements, and should be considered jointly to best improve quality.
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Affiliation(s)
- Xin Zhao
- School of International Trade and Economics, University of International Business and Economics, China.
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28
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Chenoweth L, Stein-Parbury J, White D, McNeill G, Jeon YH, Zaratan B. Coaching in self-efficacy improves care responses, health and well-being in dementia carers: a pre/post-test/follow-up study. BMC Health Serv Res 2016; 16:166. [PMID: 27146060 PMCID: PMC4855813 DOI: 10.1186/s12913-016-1410-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Accepted: 04/18/2016] [Indexed: 11/26/2022] Open
Abstract
Background Maintaining the health and well-being of family carers of people with dementia is vital, given their potential for experiencing burden associated with the role. The study aimed to help dementia carers develop self-efficacy, be less hassled by the caring role and improve their health and well-being with goal-directed behaviour, by participating in an eight module carer coaching program. Methods The study used mixed methods in a pre/post-test/follow-up design over 24 months, with assignment of consented dementia carers to either individualised (n = 16) or group coaching (n = 32), or usual carer support services (n = 43), depending on preference. Care-giving self-efficacy and hassles, carer health, well-being and goal-directed behaviours were assessed over time. Analysis of Variance (ANOVA) was used to compare changes over time and the effects of coaching on carer self-efficacy, hassles and health, using the Univariate General Linear Model (GLM). Results All carers were hassled by many aspects of caring at baseline. Participants receiving coaching reported non-significant improvements in most areas of self-efficacy for caring, hassles associated with caring and self-reported health at post-test and follow-up, than did carers receiving usual carer support. Group coaching had greater success in helping carers to achieve their goals and to seek help from informal and formal support networks and services. Conclusion The study outcomes were generally positive, but need to be interpreted cautiously, given some methodological limitations. It has been shown, however, that health staff can assist dementia carers to develop self-efficacy in better managing their family member’s limitations and behaviour, seek help from others and attend to their health. Teaching carers to use goal-directed behaviour may help them achieve these outcomes.
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Affiliation(s)
- Lynn Chenoweth
- Centre for Healthy Brain Ageing, Faculty of Medicine, University of New South Wales, Cnr. Botany/High Streets, Randwick, NSW, 2031, Australia. .,Faculty of Health, University of Technology Sydney, PO Box 123, Ultimo, NSW, 2007, Australia.
| | - Jane Stein-Parbury
- Faculty of Health, University of Technology Sydney, PO Box 123, Ultimo, NSW, 2007, Australia
| | - Danielle White
- Alzheimer's Australia New South Wales, 120 Coxs Rd (Cnr Norton Road), North Ryde, NSW, 2113, Australia
| | - Georgene McNeill
- Anglican Retirement Villages, Level 2 Century Corporate Centre, 62 Norwest Boulevarde, Baulkham Hills, NSW, 2153, Australia
| | - Yun-Hee Jeon
- Sydney Nursing School, The University of Sydney, Mallett Street, Sydney, NSW, 2050, Australia
| | - Beverley Zaratan
- Westmead Hospital, 166-174 Darcy Road, Westmead, NSW, 2145, Australia
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29
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Herr A, Hottenrott H. Higher prices, higher quality? Evidence from German nursing homes. Health Policy 2016; 120:179-89. [DOI: 10.1016/j.healthpol.2016.01.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 12/24/2015] [Accepted: 01/07/2016] [Indexed: 10/22/2022]
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30
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Allan S, Forder J. The determinants of care home closure. HEALTH ECONOMICS 2015; 24 Suppl 1:132-145. [PMID: 25760588 PMCID: PMC4403979 DOI: 10.1002/hec.3149] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 09/24/2014] [Accepted: 10/10/2014] [Indexed: 06/01/2023]
Abstract
This study investigates the causes of full closure of care homes in the English care home/nursing home market. We develop theoretical arguments about two causes for closure that are triggered by errors or external shocks: poor economic sustainability and regulatory action. Homes aiming to operate with lower quality in the market are argued for a number of reasons to be more susceptible to errors/shocks in setting quality, especially negative errors, leading to an empirical hypothesis that observed quality should negatively affect closure chance. In addition, given quality, homes facing relatively high levels of local competition should also have an increased chance of closure. We use a panel of care homes from 2008 and 2010 to examine factors affecting their closure status in subsequent years. We allow for the potential endogeneity of home quality and use multiple imputation to replace missing data. Results suggest that homes with comparatively higher quality and/or lower levels of competition have less chance of closure than other homes. We discuss that the results provide some support for the policy of regulators providing quality information to potential purchasers in the market.
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Affiliation(s)
- Stephen Allan
- Economics of Social and Health Care Research Unit, PSSRU, University of KentCanterbury, UK
| | - Julien Forder
- *
Correspondence to: University of Kent, Cornwallis Building, Canterbury, Kent, CT2 7NF, UK. E-mail:
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31
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Fernandez JL, Forder J. Local variability in long-term care services: local autonomy, exogenous influences and policy spillovers. HEALTH ECONOMICS 2015; 24 Suppl 1:146-157. [PMID: 25760589 DOI: 10.1002/hec.3151] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 11/25/2014] [Accepted: 11/25/2014] [Indexed: 06/04/2023]
Abstract
In many countries, public responsibility over the funding and provision of long-term care services is held at the local level. In such systems, long-term care provision is often characterised by significant local variability. Using a panel dataset of local authorities over the period 2002-2012, the paper investigates the underlying causes of variation in gross social care expenditure for older people in England. The analysis distinguishes between factors outside the direct control of policy makers, local preferences and local policy spillovers. The results indicate that local demand and supply factors, and to a much lesser extent local political preferences and spatial policy spillovers, explain a large majority of the observed variation in expenditure.
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Affiliation(s)
- José-Luis Fernandez
- PSSRU, London School of Economics and Political Science, London, WC2A 2AE, UK
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Gaughan J, Gravelle H, Siciliani L. Testing the bed-blocking hypothesis: does nursing and care home supply reduce delayed hospital discharges? HEALTH ECONOMICS 2015; 24 Suppl 1:32-44. [PMID: 25760581 PMCID: PMC4406135 DOI: 10.1002/hec.3150] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 11/13/2014] [Accepted: 11/20/2014] [Indexed: 05/28/2023]
Abstract
Hospital bed-blocking occurs when hospital patients are ready to be discharged to a nursing home, but no place is available, so that hospital care acts as a more costly substitute for long-term care. We investigate the extent to which greater supply of nursing home beds or lower prices can reduce hospital bed-blocking using a new Local Authority (LA) level administrative data from England on hospital delayed discharges in 2009-2013. The results suggest that delayed discharges respond to the availability of care home beds, but the effect is modest: an increase in care home beds by 10% (250 additional beds per LA) would reduce social care delayed discharges by about 6-9%. We also find strong evidence of spillover effects across LAs: more care home beds or fewer patients aged over 65 years in nearby LAs are associated with fewer delayed discharges.
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Affiliation(s)
- James Gaughan
- Centre for Health Economics, University of YorkYork, UK
| | - Hugh Gravelle
- Centre for Health Economics, University of YorkYork, UK
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