Department of Medicine, Health Policy Research Institute, University of California, Irvine, CA 92697-5800, USA.
Med Care. 2012 Oct;50(10):836-42. doi: 10.1097/MLR.0b013e318264e4ce.
Policy initiatives at the Federal and state level are aimed at increasing staffing in nursing homes. These include direct staffing standards, public reporting, and financial incentives.
To examine the impact of California's Medicaid reimbursement for nursing homes which includes incentives directed at staffing.
Two-stage limited-information maximum-likelihood regressions were used to model the relationship between staffing [registered nurses (RNs), licensed practical nurses, and certified nursing assistants hours per resident day] and the Medicaid payment rate, accounting for the specific structure of the payment system, endogeneity of payment and case-mix, and controlling for facility and market characteristics.
A total of 927 California free-standing nursing homes in 2006.
The model included facility characteristics (case-mix, size, ownership, and chain affiliation), market competition and excess demand, labor supply and wages, unemployment, and female employment. The instrumental variable for Medicaid reimbursement was the peer group payment rate for 7 geographical market areas, and the instrumental variables for resident case-mix were the average county revenues for professional therapy establishments and the percent of county population aged 65 and over.
Consistent with the rate incentives and rational expectation behavior, expected nursing home reimbursement rates in 2008 were associated with increased RN staffing levels in 2006 but had no relationship with licensed practical nurse and certified nursing assistant staffing. The effect was estimated at 2 minutes per $10 increase in rate.
The incentives in the Medicaid system impacted only RN staffing suggesting the need to improve the state's rate setting methodology.
联邦和州一级的政策举措旨在增加养老院的人员配备。这些措施包括直接人员配备标准、公共报告和财政激励。
研究加利福尼亚州对养老院的医疗补助报销的影响，其中包括针对人员配备的激励措施。
使用两阶段有限信息最大似然回归来模拟人员配备[注册护士 (RN)、持照实习护士和认证护理助理每居民日小时数]与医疗补助支付率之间的关系，考虑到支付系统的特定结构、支付的内生性和病例组合，以及控制设施和市场特征。
2006 年加利福尼亚州的 927 家独立养老院。
模型包括设施特征（病例组合、规模、所有权和连锁隶属关系）、市场竞争和过度需求、劳动力供应和工资、失业和女性就业。医疗补助报销的工具变量是 7 个地理市场区域的同行组支付率，居民病例组合的工具变量是专业治疗机构的平均县收入和 65 岁及以上人口占县总人口的百分比。
与费率激励和理性预期行为一致，2008 年预期的养老院报销率与 2006 年 RN 人员配备水平的增加相关，但与持照实习护士和认证护理助理的人员配备无关。估计的影响是每增加 10 美元费率就会增加 2 分钟。
医疗补助制度中的激励措施仅影响 RN 的人员配备，这表明需要改进该州的费率设定方法。
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