Starkey Katie Baker, Weech-Maldonado Robert, Mor Vincent
American Board of Internal Medicine, Philadelphia, PA, USA.
J Health Care Finance. 2005 Fall;32(1):67-81.
Poor quality nursing home care is a problem in the United States, a problem that threatens the lives and well-being of one of our most vulnerable populations. The competitive structure of the nursing home market may influence the strategies and behaviors nursing homes pursue to capture the resources they need to operate. The goal of this study was to determine whether nursing home quality is related to the level and type of competition present in the market. This study specifically examined whether or not a relationship exists between structural, process, and outcome quality indicators, and (1) the availability of nursing home substitutes, (2) the threat of market entry, (3) the presence of rivalry in the market, and (4) the relationship between the nursing homes and their buyers and suppliers. This study examined secondary data from the Minimum Data Set Plus (MDS +), the On-line Survey Certification of Automated Records (OSCAR), the Area Resource File (ARF), and the Medicaid Reimbursement Survey. Weighted least squares regression analysis was utilized to estimate the relationships between the quality indicators and the different aspects of competition. This study found that some forms of competition are significantly related to nursing home quality performance. The availability of nursing home substitutes, the presence of active certificate of need laws, and the level of excess demand are associated with nursing home quality.
在美国，养老院护理质量差是个问题，这一问题威胁着我们最脆弱群体之一的生命和福祉。养老院市场的竞争结构可能会影响养老院为获取运营所需资源而采取的策略和行为。本研究的目的是确定养老院质量是否与市场中竞争的程度和类型相关。本研究具体考察了结构、过程和结果质量指标与以下因素之间是否存在关系：（1）养老院替代品的可获得性；（2）市场进入威胁；（3）市场中的竞争程度；（4）养老院与其买家和供应商之间的关系。本研究分析了来自最低数据集增强版（MDS +）、自动记录在线调查认证（OSCAR）、区域资源文件（ARF）以及医疗补助报销调查的二手数据。采用加权回归分析来估计质量指标与竞争不同方面之间的关系。本研究发现，某些形式的竞争与养老院质量表现显著相关。养老院替代品的可获得性、现行的需求证明法的存在以及过度需求水平都与养老院质量相关。
