Unbiased Analysis of Today's Healthcare Issues

Free-Market Healthcare? Nursing Home Payment and Financing

Although many people believe that the U.S. healthcare system is a free-market, that is far from the case.  Consider nursing homes.  Two-thirds of patient spending on nursing home care comes from public sources.   Not only do public funds pay for the variable cost of running nursing homes, but the federal government also provides low-interest […]

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Shrinkage Estimators and Composite Quality Scores

Shrinkage estimators (such as the James-Stein estimator) are well-known in the economics literature and have a number of applications. A recent paper by Shwartz et al. 2012 demonstrates how one could apply shrinkage estimators to measure nursing home quality. “A challenge when examining individual QIs across a range of facilities is that sample sizes are […]

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The Decline of Mental Hospitals, 1950s

The movement of mental health care from mental hospitals to treatment in outpatient settings and nursing homes  began in the 1950s.  Here is how it happened. “The field of medicine where the ‘rediscovery of community’ found an immediately welcome reception was mental health services.  A movement away from mental hospitals had already begun in the […]

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Why don’t patients care about quality?

For nursing homes at least, patients do not seem to have much choice.  According to an article by Grabowski and Town: The introduction of the NHQI was generally unrelated to facility quality and consumer demand. However, nursing homes facing greater competition improved their quality more than facilities in less competitive markets…The lack of competition in […]

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State Adoption of Nursing Home Pay-for-Performance

On the importance of Nursing homes: “More than 1.5 million people reside in U.S. nursing homes at a cost of more than $120 billion per year (Kaiser Family Foundation, 2007). Medicaid is the majority payer of nursing home services, giving indigent people access to nursing home care by directly reimbursing facilities for the care of […]

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Value-Based Purchasing in Nursing Homes

More than 3 million frail and disabled individuals rely on nursing home services in any given year.  About half of these individuals consider the nursing home to be their primary place of residence.  Nursing home quality, however, has often been called into question. Some experts believe pay-for-performance schemes will improve nursing home quality.  Today, I […]

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