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PDF TRACKING FORM TrackingJobNumber 36 Printed: 02/15/2002 DocumentTitle Nursing Home QualityofCare: OBRA 1987, CompetitionandDemand Author Kumar, Virender DocumentDate 30-Sep-Ol DocumentDescription: This study detennines the effects ofOBRA 87 requiredminimumqualitystandards, market competition, and Medicaidreimbursementonthe qualityofcare and the Medicaidpopulation's access to nursing home care. Itmeasures qualityinterms ofan individual resident's death as well as anyof Project Specifics SRNumber 30-P-30238/4 ProjectNumber 00-006 ProjectTitle NursingHome QualityofCare: Time, CompetitionandDemand Awardee UniversityofNorth CarolinaatChapel Hill, Office ofResearch Services, for Department ofHealthPolicyandAdministration ProjectOfficer Hackerman, Carl Principle Investigator Kumar, Virender Funding Level 30669 StartDate 01/03/2000 EndDate 07/02/2001 ProjectDescription: Theproject assessedhowcompetitionand its influence onthe chronic health care market, and the Omnibus BudgetReconciliationActof 1987 (OBRA'87) regulations affectthe qualityofnursinghome care. Threewaves oftheNationalLongTennCare Surveywe 1 Initiated (CIVIS): sgailoway pg^g 15-Feb-02 Accepted (IQ): Date: | Released (IQ): ' Date: Received (Sub): Date: | 1 Finished (Sub): Date: QC'd (IQ): Date: 1 | \ Returned (IQ): Date. pproved (CMS): Date: j f I ^^..^ i , version 1.0 NursingHome QualityofCare: OBRA 1987, Competition and Demand Virender Kumar A dissertation submitted to the faculty ofthe University ofNorth Carolina ai Chapel Hill in partial fulfillment ofthe requirements for the degree ofDoctor ofPhilosophy in the Department ofHealth Policyand Administration, . School ofPublic Health Chapel Hill 2001 Approved by: r. Edward C. Norton, Ph.D. (Advisor) Frank A. Sloan, Ph.D. David K. Guilkey, Ph.D. nas C. Ricketts, PkD. ABSTRACT Virender Kumar Nursing Home Quality ofCare: OBRA 1987, Competition and Demand Edward C. Norton, Ph.D. (Advisor) Background: Policymakers are concerned with the quality ofnursing home care. The Omnibus Budget Reconciliation Act of 1987 (OBRA 87) was a major legislative effort to OBRA improve quality. Objective: This study determines the effects of 87 required minimum quality standards, market competition, and Medicaid reimbursement on the quality ofcare and the Medicaid population's access to nursing home care. This study measures quality ofnursing home care in terms of an individual resident's death as well as any ofthe following outcomes: bedsores, urinary-tract infection, injuries related to falls, dehydration, malnutrition, and weight-loss. Percent Medicaid residents in the facility is used to measure Medicaid population's access to care. Methods: Full-information maximum likelihood technique is used. The endogeneity of a facility's proportion of Medicaid residents and an individual's past health outcomes is accounted by using discrete factor technique that controls for common unobserved time-invariant individual- and market-level factors. Study data include observations on individuals (2,750 individuals) admitted between 1984 and 1995. Results: A higher proportion ofMedicaid residents lowers the quality ofnursing home care. The analysis suggests that OBRA 87 improved quality ofnursing home care, while reducing access to such care for the Medicaid population. Competition among nursing homes improves access to care for the Medicaid population. Conclusions: The findings suggest ii U II 11 that although government-required minimum quahty standards improve the quahty of nursing home care, they also reduce Medicaid population's access to nursing home care. Requiring nursing home to have at least a certain percent ofprivate payers to receive Medicare and Medicaid certification may improve quality ofnursing home care. Increasing competition may improve access to nursing home care for the Medicaid population. iii