The Impact of Minimum Quality Standard Regulations on Nursing Home Staffing, Quality, and Exit Decisions

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• 作者：John R. Bowblis ; Andrew Ghattas
• 关键词：Minimum quality standards ; Regulation ; Nursing homes ; Nurse staff levels ; Nurse staff composition ; Exit
• 刊名：Review of Industrial Organization
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：50
• 期：1
• 页码：43-68
• 全文大小：
• 刊物类别：Business and Economics
• 刊物主题：Industrial Organization; Microeconomics;
• 出版者：Springer US
• ISSN：1573-7160
• 卷排序：50

文摘

The regulation of nursing homes in the U.S. often includes mandates that require a minimum nurse staffing level. In this paper, we exploit new minimum nurse staffing regulations by the states of New Mexico and Vermont that were implemented in the early 2000s to determine how nursing homes responded in terms of staffing, quality, and the decision to exit the market. Our identification strategy exploits the fact that some nursing homes had pre-regulatory staffing levels near the new requirement and did not need to change staffing levels. We compare these nursing homes to a group that faced binding constraints (low-staffed) and those that were significantly over the constraint (high-staffed). Low-staffed nursing homes increase staffing levels but also use less expensive nurse types to satisfy the new standard. High-staffed nursing homes decrease staffing and use fewer contracted staff. Overall, dispersion in staffing is reduced, but we find little effect by pre-regulatory staffing level on non-staffing measures of quality and the decision to exit the market.