Winblad Ulrika, Blomqvist Paula, Karlsson Andreas
Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
Department of Government, Uppsala University, Uppsala, Sweden.
BMC Health Serv Res. 2017 Jul 14;17(1):487. doi: 10.1186/s12913-017-2403-0.
Swedish nursing home care has undergone a transformation, where the previous virtual public monopoly on providing such services has been replaced by a system of mixed provision. This has led to a rapidly growing share of private actors, the majority of which are large, for-profit firms. In the wake of this development, concerns have been voiced regarding the implications for care quality. In this article, we investigate the relationship between ownership and care quality in nursing homes for the elderly by comparing quality levels between public, for-profit, and non-profit nursing home care providers. We also look at a special category of for-profit providers; private equity companies.
The source of data is a national survey conducted by the Swedish National Board of Health and Welfare in 2011 at 2710 nursing homes. Data from 14 quality indicators are analyzed, including structure and process measures such as staff levels, staff competence, resident participation, and screening for pressure ulcers, nutrition status, and risk of falling. The main statistical method employed is multiple OLS regression analysis. We differentiate in the analysis between structural and processual quality measures.
The results indicate that public nursing homes have higher quality than privately operated homes with regard to two structural quality measures: staffing levels and individual accommodation. Privately operated nursing homes, on the other hand, tend to score higher on process-based quality indicators such as medication review and screening for falls and malnutrition. No significant differences were found between different ownership categories of privately operated nursing homes.
Ownership does appear to be related to quality outcomes in Swedish nursing home care, but the results are mixed and inconclusive. That staffing levels, which has been regarded as a key quality indicator in previous research, are higher in publicly operated homes than private is consistent with earlier findings. The fact that privately operated homes, including those operated by for-profit companies, had higher processual quality is more unexpected, given previous research. Finally, no significant quality differences were found between private ownership types, i.e. for-profit, non-profit, and private equity companies, which indicates that profit motives are less important for determining quality in Swedish nursing home care than in other countries where similar studies have been carried out.
瑞典的养老院护理已经历了一场变革，以往几乎由公共部门垄断提供此类服务的局面已被混合供给体系所取代。这导致了私人行为主体的份额迅速增长，其中大多数是大型盈利性公司。随着这一发展，人们对护理质量的影响表示担忧。在本文中，我们通过比较公立、盈利性和非营利性养老院护理提供者的质量水平，研究了老年养老院所有权与护理质量之间的关系。我们还考察了一类特殊的盈利性提供者；私募股权公司。
数据来源是瑞典国家卫生和福利委员会2011年对2710家养老院进行的全国性调查。分析了来自14个质量指标的数据，包括结构和过程指标，如员工水平、员工能力、居民参与度，以及压力性溃疡筛查、营养状况和跌倒风险。主要采用的统计方法是多元OLS回归分析。我们在分析中区分了结构质量指标和过程质量指标。
结果表明，在两项结构质量指标方面，公立养老院的质量高于私立养老院：人员配备水平和单人住宿。另一方面，私立养老院在基于过程的质量指标上得分往往更高，如药物审查以及跌倒和营养不良筛查。不同所有权类别的私立养老院之间未发现显著差异。
在瑞典养老院护理中，所有权似乎确实与质量结果相关，但结果喜忧参半且尚无定论。在以往研究中被视为关键质量指标的人员配备水平，公立养老院高于私立养老院，这与早期研究结果一致。鉴于以往研究，私立养老院（包括盈利性公司运营的养老院）具有更高的过程质量这一事实更出人意料。最后，在私有制类型（即盈利性、非营利性和私募股权公司）之间未发现显著的质量差异，这表明在瑞典养老院护理中，利润动机对质量的决定作用不如在进行过类似研究的其他国家那么重要。
