Paying for the view?

How nursing home prices affect certified staffing ratios

verfasst von

Dörte Heger, Annika Herr, Anne Mensen

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.

Organisationseinheit(en)

Institut für Gesundheitsökonomie

Externe Organisation(en)

RWI - Leibniz-Institut für Wirtschaftsforschung e.V.
CINCH - Forschungszentrum für Gesundheitsökonomik
Ruhr-Universität Bochum

Typ

Artikel

Journal

Health Economics (United Kingdom)

Band

31

Seiten

1618-1632

Anzahl der Seiten

15

ISSN

1057-9230

Publikationsdatum

05.07.2022

Publikationsstatus

Veröffentlicht

Peer-reviewed

Ja

ASJC Scopus Sachgebiete

Health policy

Ziele für nachhaltige Entwicklung

SDG 3 – Gute Gesundheit und Wohlergehen

Elektronische Version(en)

https://doi.org/10.1002/hec.4532 (Zugang: Offen)