Public reporting and the quality of care of German nursing homes.
OBJECTIVE
Since 2009, German nursing homes have been evaluated regularly by an external institution with quality report cards published online. We follow recent debates and argue that most of the information in the report cards does not reliably measure quality of care. However, a subset of up to seven measures does. Do these measures that reflect "risk factors" improve over time?


METHODS
Using a sample of more than 3000 German nursing homes with information on two waves, we assume that the introduction of public reporting is an exogenous institutional change and apply before-after-estimations to obtain estimates for the relation between public reporting and quality.


RESULTS
We find a significant improvement of the identified risk factors. Also, the two employed outcome quality indicators improve significantly. The improvements are driven by nursing homes with low quality in the first evaluation.


CONCLUSIONS
To the extent that this can be interpreted as evidence that public reporting positively affects the (reported) quality in nursing homes, policy makers should carefully choose indicators reflecting care-sensitive quality.
Düsseldorf Institute for Competition Economics (DICE), Heinrich-Heine-University Düsseldorf, Universitätsstrasse 1, 40225 Düsseldorf, Germany; CINCH - Health Economics Research Center, Universität Duisburg-Essen Weststadttürme, Berliner Platz 6-8, 45127 Essen, Germany. Electronic address: annika.herr@dice.hhu.de.
Annika
A
Herr
Düsseldorf Institute for Competition Economics (DICE), Heinrich-Heine-University Düsseldorf, Universitätsstrasse 1, 40225 Düsseldorf, Germany; CINCH - Health Economics Research Center, Universität Duisburg-Essen Weststadttürme, Berliner Platz 6-8, 45127 Essen, Germany. Electronic address: thu-van.nguyen@wiwinf.uni-due.de.
Thu-Van
TV
Nguyen
CINCH - Health Economics Research Center, Universität Duisburg-Essen Weststadttürme, Berliner Platz 6-8, 45127 Essen, Germany; University of Paderborn, Warburger Strasse 100, 33098 Paderborn, Germany; RWI, Hohenzollernstraße 1-3, 45128 Essen, Germany. Electronic address: hendrik.schmitz@uni-paderborn.de.
Hendrik
H
Schmitz
D005858:Germany; D006801:Humans; D019221:Mandatory Reporting; D009735:Nursing Homes / Q000458:organization & administration / Q000592:standards*; D010043:Outcome and Process Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data*; D058996:Quality Improvement / Q000592:standards / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000592:standards*; D012307:Risk Factors
Information; Long-term care; Nursing homes; Public reporting; Quality