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Home Costs (home + cost)

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Medical Sciences60%

Selected Abstracts

Does Prospective Payment Really Contain Nursing Home Costs?

HEALTH SERVICES RESEARCH, Issue 2 2002
Li-Wu Chen
Objective. To examine whether nursing homes would behave more efficiently, without compromising their quality of care, under prospective payment. Data Sources. Four data sets for 1994: the Skilled Nursing Facility Minimum Data Set, the Online Survey Certification and Reporting System file, the Area Resource File, and the Hospital Wage Indices File. A national sample of 4,635 nursing homes is included in the analysis. Study Design. Using a modified hybrid functional form to estimate nursing home costs, we distinguish our study from previous research by controlling for quality differences (related to both care and life) and addressing the issues of output and quality endogeneity, as well as using more recent national data. Factor analysis was used to operationalize quality variables. To address the endogeneity problems, instrumental measures were created for nursing home output and quality variables. Principal Findings. Nursing homes in states using prospective payment systems do not have lower costs than their counterpart facilities under retrospective cost-based payment systems, after quality differences among facilities are controlled for and the endogeneity problem of quality variables is addressed. Conclusions. The effects of prospective payment on nursing home cost reduction may be through quality cuts, rather than cost efficiency. If nursing home payments under prospective payment systems are not adjusted for quality, nursing homes may respond by cutting their quality levels, rather than controlling costs. Future outcomes research may provide useful insights into the adjustment of quality in the design of prospective payment for nursing home care. [source]

The Effects of Case-Mix Reimbursement on Ohio Medicaid Nursing Home Costs

POLICY STUDIES JOURNAL, Issue 3 2002
Sunday E. Ubokudom
This article examines empirically the effects of the Ohio case-mix reimbursement system on nursing home costs. The results show that case-mix is the single most important factor affecting both direct-care (nursing staff) and total per diem costs. Although other factors, such as bedsize, occupancy rate, ownership status, county per capita income, and the demand for nursing home care, also affeet costs; they have far smaller effects on costs than case-mix. Further, the results show that the cost differentials between for-profit and nonprofit facilities are largely explained by differences in cost response to case-mix and, to a lesser extent, by differences in cost response to bedsize, Medicaid utilization, county per capita income, demand for nursing home beds, and occupancy rate. The for-profit facilities in this study cost significantly less than their nonprofit counterparts. [source]

Does Prospective Payment Really Contain Nursing Home Costs?

HEALTH SERVICES RESEARCH, Issue 2 2002
Li-Wu Chen
Objective. To examine whether nursing homes would behave more efficiently, without compromising their quality of care, under prospective payment. Data Sources. Four data sets for 1994: the Skilled Nursing Facility Minimum Data Set, the Online Survey Certification and Reporting System file, the Area Resource File, and the Hospital Wage Indices File. A national sample of 4,635 nursing homes is included in the analysis. Study Design. Using a modified hybrid functional form to estimate nursing home costs, we distinguish our study from previous research by controlling for quality differences (related to both care and life) and addressing the issues of output and quality endogeneity, as well as using more recent national data. Factor analysis was used to operationalize quality variables. To address the endogeneity problems, instrumental measures were created for nursing home output and quality variables. Principal Findings. Nursing homes in states using prospective payment systems do not have lower costs than their counterpart facilities under retrospective cost-based payment systems, after quality differences among facilities are controlled for and the endogeneity problem of quality variables is addressed. Conclusions. The effects of prospective payment on nursing home cost reduction may be through quality cuts, rather than cost efficiency. If nursing home payments under prospective payment systems are not adjusted for quality, nursing homes may respond by cutting their quality levels, rather than controlling costs. Future outcomes research may provide useful insights into the adjustment of quality in the design of prospective payment for nursing home care. [source]

The Effects of Case-Mix Reimbursement on Ohio Medicaid Nursing Home Costs

POLICY STUDIES JOURNAL, Issue 3 2002
Sunday E. Ubokudom
This article examines empirically the effects of the Ohio case-mix reimbursement system on nursing home costs. The results show that case-mix is the single most important factor affecting both direct-care (nursing staff) and total per diem costs. Although other factors, such as bedsize, occupancy rate, ownership status, county per capita income, and the demand for nursing home care, also affeet costs; they have far smaller effects on costs than case-mix. Further, the results show that the cost differentials between for-profit and nonprofit facilities are largely explained by differences in cost response to case-mix and, to a lesser extent, by differences in cost response to bedsize, Medicaid utilization, county per capita income, demand for nursing home beds, and occupancy rate. The for-profit facilities in this study cost significantly less than their nonprofit counterparts. [source]

The economic impact of overactive bladder syndrome in six Western countries

BJU INTERNATIONAL, Issue 2 2009
Debra E. Irwin
OBJECTIVE To calculate up-to-date estimates of the economic impact of overactive bladder syndrome (OAB) with and without urgency urinary incontinence (UUI) on the health sector of six countries (Canada, Germany, Italy, Spain, Sweden and the UK), as OAB is a significant health concern for adults aged >18 years living in Western countries. MATERIALS AND METHODS The prevalence data derived from the EPIC study were combined with healthcare resource-use data to derive current direct and indirect 1-year or annual cost of illness estimates for OAB including UUI in Canada, Germany, Italy, Spain, Sweden and the UK. This model estimates the direct healthcare costs attributed to OAB, as well as the impact of work absenteeism. RESULTS The estimated average annual direct cost of OAB per patient ranged between ,262 in Spain and ,619 in Sweden. The estimated total direct cost burden for OAB per country ranges between ,333 million in Sweden and ,1.2 billion in Germany and the total annual direct cost burden of OAB in these six countries is estimated at ,3.9 billion. In addition, nursing home costs were estimated at ,4.7 billion per year and it was estimated that work absenteeism related to OAB costs ,1.1 billion per year. CONCLUSIONS The cost of illness for OAB is a substantial economic and human burden. This study may under-estimate the true economic burden, as not all costs for sequelae associated with OAB have been included. Cost-effective treatments and management strategies that can reduce the burden of OAB and in particular UUI have the potential to significantly reduce this economic burden. [source]