title: Effect of nursing home ownership on the quality of post-acute care: an instrumental variables approach.
abstract: Given the preferential tax treatment afforded nonprofit firms, policymakers and researchers have been interested in whether the nonprofit sector provides higher nursing home quality relative to its for-profit counterpart. However, differential selection into for-profits and nonprofits can lead to biased estimates of the effect of ownership form. By using "differential distance" to the nearest nonprofit nursing home relative to the nearest for-profit nursing home, we mimic randomization of residents into more or less "exposure" to nonprofit homes when estimating the effects of ownership on quality of care. Using national Minimum Data Set assessments linked with Medicare claims, we use a national cohort of post-acute patients who were newly admitted to nursing homes within an 18-month period spanning January 1, 2004 and June 30, 2005. After instrumenting for ownership status, we found that post-acute patients in nonprofit facilities had fewer 30-day hospitalizations and greater improvement in mobility, pain, and functioning.
authors.affiliation: Harvard University, Department of Health Care Policy, Boston, MA 02115-5899, USA. grabowski@med.harvard.edu
authors.forename: David C
authors.initials: DC
authors.lastname: Grabowski
authors.forename: Zhanlian
authors.initials: Z
authors.lastname: Feng
authors.forename: Richard
authors.initials: R
authors.lastname: Hirth
authors.forename: Momotazur
authors.initials: M
authors.lastname: Rahman
authors.forename: Vincent
authors.initials: V
authors.lastname: Mor
mesh_terms: D000208:Acute Disease / Q000534:rehabilitation / Q000628:therapy; D000369:Aged, 80 and over; D005260:Female; D006269:Health Facilities, Proprietary / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D006278:Medicare / Q000191:economics / Q000706:statistics & numerical data; D009735:Nursing Homes / Q000191:economics / Q000458:organization & administration / Q000592:standards*; D009939:Organizations, Nonprofit / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data; D010067:Ownership / Q000191:economics / Q000706:statistics & numerical data; D019984:Quality Indicators, Health Care / Q000191:economics / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000191:economics* / Q000706:statistics & numerical data; D014481:United States