Nursing home quality of care : OBRA 1987, competition and demand

450 Pages·2001·14.2 MB·English

by  Kumar, Virender

PDF TRACKING FORM
TrackingJobNumber 36 Printed: 02/15/2002
DocumentTitle Nursing Home QualityofCare: OBRA 1987, CompetitionandDemand
Author Kumar, Virender DocumentDate 30-Sep-Ol
DocumentDescription: This study detennines the effects ofOBRA 87 requiredminimumqualitystandards, market
competition, and Medicaidreimbursementonthe qualityofcare and the Medicaidpopulation's access
to nursing home care. Itmeasures qualityinterms ofan individual resident's death as well as anyof
Project Specifics
SRNumber 30-P-30238/4
ProjectNumber 00-006
ProjectTitle NursingHome QualityofCare: Time, CompetitionandDemand
Awardee UniversityofNorth CarolinaatChapel Hill, Office ofResearch Services, for
Department ofHealthPolicyandAdministration
ProjectOfficer Hackerman, Carl
Principle Investigator Kumar, Virender
Funding Level 30669
StartDate 01/03/2000
EndDate 07/02/2001
ProjectDescription: Theproject assessedhowcompetitionand its influence onthe chronic health care
market, and the Omnibus BudgetReconciliationActof 1987 (OBRA'87) regulations
affectthe qualityofnursinghome care. Threewaves oftheNationalLongTennCare
Surveywe
1 Initiated (CIVIS): sgailoway pg^g 15-Feb-02 Accepted (IQ): Date:
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Released (IQ): ' Date: Received (Sub): Date:
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1 Finished (Sub): Date: QC'd (IQ): Date:
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Returned (IQ): Date. pproved (CMS): Date:
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version 1.0

NursingHome QualityofCare: OBRA 1987, Competition and Demand
Virender Kumar
A dissertation submitted to the faculty ofthe University ofNorth Carolina ai Chapel Hill
in partial fulfillment ofthe requirements for the degree ofDoctor ofPhilosophy
in the Department ofHealth Policyand Administration,
.
School ofPublic Health
Chapel Hill
2001
Approved by:
r.
Edward C. Norton, Ph.D. (Advisor)
Frank A. Sloan, Ph.D.
David K. Guilkey, Ph.D.
nas C. Ricketts, PkD.

ABSTRACT
Virender Kumar
Nursing Home Quality ofCare: OBRA 1987, Competition and Demand
Edward C. Norton, Ph.D. (Advisor)
Background: Policymakers are concerned with the quality ofnursing home care. The
Omnibus Budget Reconciliation Act of 1987 (OBRA 87) was a major legislative effort to
OBRA
improve quality. Objective: This study determines the effects of 87 required
minimum quality standards, market competition, and Medicaid reimbursement on the quality
ofcare and the Medicaid population's access to nursing home care. This study measures
quality ofnursing home care in terms of an individual resident's death as well as any ofthe
following outcomes: bedsores, urinary-tract infection, injuries related to falls, dehydration,
malnutrition, and weight-loss. Percent Medicaid residents in the facility is used to measure
Medicaid population's access to care. Methods: Full-information maximum likelihood
technique is used. The endogeneity of a facility's proportion of Medicaid residents and an
individual's past health outcomes is accounted by using discrete factor technique that controls
for common unobserved time-invariant individual- and market-level factors. Study data
include observations on individuals (2,750 individuals) admitted between 1984 and 1995.
Results: A higher proportion ofMedicaid residents lowers the quality ofnursing home care.
The analysis suggests that OBRA 87 improved quality ofnursing home care, while reducing
access to such care for the Medicaid population. Competition among nursing homes
improves access to care for the Medicaid population. Conclusions: The findings suggest
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that although government-required minimum quahty standards improve the quahty of
nursing home care, they also reduce Medicaid population's access to nursing home care.
Requiring nursing home to have at least a certain percent ofprivate payers to receive
Medicare and Medicaid certification may improve quality ofnursing home care. Increasing
competition may improve access to nursing home care for the Medicaid population.
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