Nyman J A
Center for Health Services Research, University of Iowa, Iowa City 52242.
Health Serv Res. 1988 Oct;23(4):555-74.
The for-profit nursing home's incentive to minimize costs has been maligned as a major cause of the quality problems that have traditionally plagued the nursing home care industry. Yet, profit-maximizing firms in other industries are able to produce products of adequate quality. In most other industries, however, firms are constrained from reducing costs to the point where quality suffers by the threat of losing business to competing firms. In the nursing home industry, competition for patients often does not exist because of the shortage of nursing home beds. As a result, one would expect that nursing homes located in areas where there is excess demand would spend less on patient care than homes located where the bed supply is relatively abundant. This hypothesis is tested using Wisconsin data from 1983. It is found that, in counties with relatively tight bed supplies, an additional empty bed in all the homes in the county will force each home to increase expenditures by $.62 per day for each patient in the home. Overall, the average nursing home located in underbedded markets would spend $5.12 more per patient day or about $240,000 more annually (in 1983 dollars) if it were located in a market where it was forced to compete for patients. The implications for public policy are discussed.
营利性养老院为将成本降至最低所采取的激励措施，一直被诟病为传统上困扰养老院护理行业质量问题的主要原因。然而，其他行业追求利润最大化的公司却能够生产出质量合格的产品。然而，在大多数其他行业中，公司会因担心被竞争公司抢走业务，而无法将成本削减到影响质量的程度。在养老院行业，由于养老院床位短缺，患者竞争往往不存在。因此，人们会认为，在需求过剩地区的养老院，在患者护理方面的支出会比床位供应相对充足地区的养老院少。本研究使用1983年威斯康星州的数据对这一假设进行了检验。研究发现，在床位供应相对紧张的县，全县所有养老院中每多一张空床位，会迫使每家养老院为其每位患者每天增加0.62美元的支出。总体而言，如果位于床位供应不足市场的普通养老院被迫在竞争患者的市场中运营，那么它将为每位患者每天多支出5.12美元，或每年多支出约24万美元（以1983年美元计算）。本文还讨论了对公共政策的影响。
