title: Trade-off Between Quality, Price, and Profit Orientation in Germany's Nursing Homes.
abstract: International data suggest that for-profit nursing homes tend to provide lower quality than not-for-profit nursing homes. In Germany, the relationships between profit orientation, price and quality of nursing homes have not been investigated. We performed an observational study using secondary data from statutory quality audits of all nursing homes in Germany. The relationships were analyzed bivariately via Mann-WhitneyU-Test and Kruskal-Wallis Test respectively, followed by a multivariate variance analysis which also covered the interaction effect between quality, price and type of ownership. 41 % of 10,168 German nursing homes were for-profit charging on average about 10 % less than not-for-profit homes. In five out of six quality categories under study, for-profit nursing homes provided lower quality than not-for-profit homes. Quality of care in all quality categories improved with increasing prices per day. However, for four out of six quality categories examined, the quality difference between for-profit and non-profit nursing homes existed independent of the price charged. When selecting a nursing home it is therefore advisable to consider the profit orientation of the institution. German legislation should require that statutory public quality reports contain details on the profit orientation of nursing homes.
authors.affiliation: Institute for Health Systems Research, School of Medicine, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Strasse 50, 58448 Witten, Germany.
authors.forename: Max
authors.initials: M
authors.lastname: Geraedts
authors.affiliation: Department of Social and Behavioral Sciences, University of California, San Francisco, 3333 California St., Suite 410, San Francisco, CA 94143 USA.
authors.forename: Charlene
authors.initials: C
authors.lastname: Harrington
authors.affiliation: Institute for Health Systems Research, School of Medicine, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Strasse 50, 58448 Witten, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Schumacher
authors.affiliation: Institute for Health Systems Research, School of Medicine, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Strasse 50, 58448 Witten, Germany.
authors.forename: Rike
authors.initials: R
authors.lastname: Kraska
keywords: Germany; Nursing homes; Ownership; Profit orientation; Quality of care