Does State Regulation of Quality Impose Costs on Nursing Homes?
Does State Regulation of Quality Impose Costs on Nursing Homes?
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DOI：
10.1097/mlr.0b013e318207ef9e
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发表时间：
2011-06-01
期刊：
影响因子：
3
通讯作者：
Bailey, Lauren
中科院分区：
文献类型：
--
作者：
Mukamel, Dana B.;Li, Yue;Bailey, Lauren
背景：政府监管旨在提高被监管行业的质量、安全、公平或竞争。这样的监管既有直接成本，也有间接成本。目的：评估与养老院行业质量监管相关的成本。样本：本研究包括2004年至2006年间全国11168家独立养老院。研究设计：数据包括来自医疗保险成本报告、最小数据集、医疗保险分母文件、OSCAR和作者进行的各州认证和许可办公室调查的信息。这些数据被用来创建衡量养老院成本、产出、工资、竞争、调整缺陷引用、所有权、国家固定效应的变量，以及每个州监管严格程度的指数。我们估计了混合成本函数，其中包括监管严格指数。结果：估算成本函数表现出疗养院成本函数的典型行为期望。严格指数与成本呈正相关且显著，表明位于监管要求更严格的州的养老院面临更高的成本，其他条件相同。严格度指数每增加1个标准差，成本就会增加1.1%。结论：本研究首次对养老院的质量监管进行了价格标签。它提供了一个数量级的行业成本，以遵守目前的一套标准，并考虑到目前的执行水平。需要对这些条例所带来的好处进行补充性研究，以便对条例的效果进行全面评估。
Background: Government regulation is intended to enhance quality, safety, fairness, or competition in the regulated industry. Such regulation entails both direct and indirect costs.Objectives: To estimate the costs associated with the regulation of quality of the nursing home industry.Sample: This study includes 11,168 free-standing nursing homes nationally, between 2004 and 2006.Research Design: Data included information from the Medicare cost reports, Minimum Data Set, Medicare Denominator file, OSCAR, and a survey of States' Certification and Licensing Offices conducted by the authors. These data were used to create variables measuring nursing homes costs, outputs, wages, competition, adjusted deficiency citations, ownership, state-fixed effects, and an index of each state's regulatory stringency. We estimated hybrid cost functions which included the regulatory stringency index.Results: The estimated cost functions demonstrated the typical behavior expected of nursing home cost functions. The stringency index was positively and significantly associated with costs, indicating that nursing homes located in states with more stringent regulatory requirements face higher costs, ceteris paribus. The average incremental costs of a 1 standard deviation increase in the stringency index resulted in a 1.1% increase in costs.Conclusions: This study for the first time places a price tag on the regulation of quality in nursing homes. It offers an order of magnitude on the costs to the industry of complying with the current set of standards and given the current level of enforcement. Complementary studies of the benefits that these regulations entail are needed to gain a comprehensive assessment of the effect of the regulation.