Harrington Charlene, Swan James H, Carrillo Helen
Department of Social & Behavioral Sciences, University of California, San Francisco, CA 94118, USA.
Health Serv Res. 2007 Jun;42(3 Pt 1):1105-29. doi: 10.1111/j.1475-6773.2006.00641.x.
To examine the relationship between nursing staffing levels in U.S. nursing homes and state Medicaid reimbursement rates.
Facility staffing, characteristics, and case-mix data were from the federal On-Line Survey Certification and Reporting (OSCAR) system and other data were from public sources.
Ordinary least squares and two-stage least squares regression analyses were used to separately examine the relationship between registered nurse (RN) and total nursing hours in all U.S. nursing homes in 2002, with two endogenous variables: Medicaid reimbursement rates and resident case mix.
RN hours and total nursing hours were endogenous with Medicaid reimbursement rates and resident case mix. As expected, Medicaid nursing home reimbursement rates were positively related to both RN and total nursing hours. Resident case mix was a positive predictor of RN hours and a negative predictor of total nursing hours. Higher state minimum RN staffing standards was a positive predictor of RN and total nursing hours while for-profit facilities and the percent of Medicaid residents were negative predictors.
To increase staffing levels, average Medicaid reimbursement rates would need to be substantially increased while higher state minimum RN staffing standards is a stronger positive predictor of RN and total nursing hours.
研究美国疗养院护理人员配备水平与州医疗补助报销率之间的关系。
机构人员配备、特征和病例组合数据来自联邦在线调查认证与报告（OSCAR）系统，其他数据来自公共来源。
采用普通最小二乘法和两阶段最小二乘法回归分析，分别研究2002年美国所有疗养院注册护士（RN）和总护理时长之间的关系，有两个内生变量：医疗补助报销率和居民病例组合。
RN时长和总护理时长与医疗补助报销率和居民病例组合存在内生关系。正如预期的那样，疗养院医疗补助报销率与RN时长和总护理时长均呈正相关。居民病例组合是RN时长的正向预测指标，是总护理时长的负向预测指标。较高的州最低RN人员配备标准是RN时长和总护理时长的正向预测指标，而营利性机构和医疗补助居民比例则是负向预测指标。
为提高人员配备水平，需要大幅提高医疗补助平均报销率，而较高的州最低RN人员配备标准是RN时长和总护理时长更强的正向预测指标。
