Best of the 2012 Academy Health Annual Research Meeting
The Effect of State Regulatory Stringency on Nursing Home Quality
Article first published online: 4 SEP 2012
© Health Research and Educational Trust
Health Services Research
Volume 47, Issue 5, pages 1791–1813, October 2012
How to Cite
Mukamel, D. B., Weimer, D. L., Harrington, C., Spector, W. D., Ladd, H. and Li, Y. (2012), The Effect of State Regulatory Stringency on Nursing Home Quality. Health Services Research, 47: 1791–1813. doi: 10.1111/j.1475-6773.2012.01459.x
- Issue published online: 17 SEP 2012
- Article first published online: 4 SEP 2012
- National Institutes on Aging. Grant Number: AG027420
- Nursing homes;
- quality of care;
- comparative effectiveness
To test the hypothesis that more stringent quality regulations contribute to better quality nursing home care and to assess their cost-effectiveness.
Primary and secondary data from all states and U.S. nursing homes between 2005 and 2006.
We estimated seven models, regressing quality measures on the Harrington Regulation Stringency Index and control variables. To account for endogeneity between regulation and quality, we used instrumental variables techniques. Quality was measured by staffing hours by type per case-mix adjusted day, hotel expenditures, and risk-adjusted decline in activities of daily living, high-risk pressure sores, and urinary incontinence.
All states' licensing and certification offices were surveyed to obtain data about deficiencies. Secondary data included the Minimum Data Set, Medicare Cost Reports, and the Economic Freedom Index.
Regulatory stringency was significantly associated with better quality for four of the seven measures studied. The cost-effectiveness for the activities-of-daily-living measure was estimated at about 72,000 in 2011/ Quality Adjusted Life Year.
Quality regulations lead to better quality in nursing homes along some dimensions, but not all. Our estimates of cost-effectiveness suggest that increased regulatory stringency is in the ballpark of other acceptable cost-effective practices.