Lord Justin, Weech-Maldonado Robert, Blackburn Justin, Carroll Nathaniel
Health Care Manage Rev. 2021;46(3):E50-E60. doi: 10.1097/HMR.0000000000000297. Epub 2020 Nov 12.
Nursing homes face increased risk of closure because of poor financial performance.
Using resource dependency theory, Porter's Five Forces of Competition framework, and Altman's Z -score model, this study examines the relationship between market factors and nursing home financial distress.
METHODOLOGY/APPROACH: This study utilizes Medicare Cost Reports, LTCFocus, Certification and Survey Provider Enhanced Reporting, Online Survey Certification and Reporting, and the Area Health Resource File to examine an average of 10,454 nursing homes per year from 2000 to 2015. Using Porter's framework, market factors were conceptualized as the bargaining power of buyers and suppliers, threat of substitutes and new entrants, and industry rivalry. Organizational control variables include occupancy, payer mix, size, and chain affiliation. Data were analyzed using multinomial logistic regression with robust clustering, year, and state fixed effects.
Distressed nursing homes (Relative Risk Ratios [RRR] = 0.991) were less likely to be in counties with higher Medicaid concentration. Distressed (RRR = 0.717) and at-risk-of-distress nursing homes (RRR = 0.807) were less likely to be in markets with home health agencies, and nursing homes at risk of distress (RRR = 1.005) were more likely to be in markets with a higher number of hospital-based skilled nursing facility beds compared to healthy organizations. The organizational-level variables, occupancy, payer mix, size, and chain affiliation had a significant impact on nursing home financial distress.
The effects of external market forces on nursing home financial distress were limited; however, organizational-level variables had a significant impact on nursing home financial distress.
Study findings can inform policy makers on specific factors associated with nursing home financial distress and provide greater insight as it relates to designing new policies and interventions.
由于财务表现不佳，养老院面临着更高的倒闭风险。
本研究运用资源依赖理论、波特五力竞争框架和奥特曼Z计分模型，考察市场因素与养老院财务困境之间的关系。
方法/途径：本研究利用医疗保险成本报告、长期护理聚焦、认证与调查提供者强化报告、在线调查认证与报告以及地区卫生资源文件，对2000年至2015年期间平均每年10454家养老院进行考察。运用波特框架，将市场因素概念化为买家和供应商的议价能力、替代品和新进入者的威胁以及行业竞争。组织控制变量包括入住率、付款人组合、规模和连锁关系。数据采用具有稳健聚类、年份和州固定效应的多项逻辑回归进行分析。
陷入财务困境的养老院（相对风险比率[RRR]=0.991）在医疗补助集中度较高的县出现的可能性较小。陷入困境的养老院（RRR=0.717）和有陷入财务困境风险的养老院（RRR=0.807）在有家庭健康机构的市场中出现的可能性较小，而有陷入财务困境风险的养老院（RRR=1.005）与健康机构相比，在拥有更多医院附属专业护理机构床位的市场中出现的可能性更大。组织层面的变量，即入住率、付款人组合、规模和连锁关系，对养老院的财务困境有显著影响。
外部市场力量对养老院财务困境的影响有限；然而，组织层面的变量对养老院财务困境有显著影响。
研究结果可为政策制定者提供与养老院财务困境相关的具体因素信息，并在设计新政策和干预措施方面提供更深入的见解。
