Driven to tiers: Socioeconomic and racial disparities in the quality of nursing home care
Driven to tiers: Socioeconomic and racial disparities in the quality of nursing home care
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DOI：
10.1111/j.0887-378x.2004.00309.x
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发表时间：
2004-01-01
影响因子：
6.6
通讯作者：
Miller, SC
中科院分区：
文献类型：
--
作者：
Mor, V;Zinn, J;Miller, SC
养老院护理目前是一个两级系统。较低级别由主要为医疗补助居民提供住房的设施组成，因此资源非常有限。近15%的美国非医院疗养院主要为医疗补助居民提供服务，这些疗养院的护士更少，入住率更低，与健康相关的缺陷更多。与其他设施相比，它们更有可能被终止医疗补助/医疗保险计划，不成比例地位于最贫穷的县，更有可能为非裔美国人居民服务。公开报告质量指标，旨在通过市场机制提高质量，可能会导致贫困家庭倒闭，并将对生活在贫困社区的非白人居民造成不成比例的影响。本文建议采取积极的政策立场，以减轻质量竞争的这些后果。
Nursing home care is currently a two-tiered system. The lower tier consists of facilities housing mainly Medicaid residents and, as a result, has very limited resources. The nearly 15 percent of U.S. nonhospital-based nursing homes that serve predominantly Medicaid residents have fewer nurses, lower occupancy rates, and more health-related deficiencies. They are more likely to be terminated from the Medicaid/Medicare program, are disproportionately located in the poorest counties, and are more likely to serve African-American residents than are other facilities. The public reporting of quality indicators, intended to improve quality through market mechanisms, may result in driving poor homes out of business and will disproportionately affect nonwhite residents living in poor communities. This article recommends a proactive policy stance to mitigate these consequences of quality competition.