| Nursing homes plays a vital role in meeting Americans' long-term health care needs. Nearly two-thirds of the facilities are organized for-profit. This study evaluates the relationship between Medicaid reimbursement and quality and whether the relationship differs based on profit status.; Using calendar year 2000 Medicaid cost report data (n = 536), quality was measured using case-mix adjusted nurse staffing ratios (NSRs), i.e., the ratio of the amount of nursing time provided divided by the amount of nursing time needed based on residents' classification into one of 44 Resource Utilization Groups (RUGs). The differences between NFPs and FPs sectors on all nursing, RN, LPN, and nurse aide nurse staffing ratios were statistically significant with NFPs providing 26, 4, 4, and 18 more minutes, respectively, for residents with average nursing care requirements.; Profit status was found to have a negative relationship with quality when controlling for revenues. In stratified linear regression analysis using OLS, nurse aide, LPN, and RN NSRs were regressed on three Ohio Medicaid per diem rate components controlling for other financial resources. The rate per case mix unit, the rate compensating facilities for nurse staffing, had a positive relationship with both sectors with no statistically significant differences based on strength. An incentive payment, paid to facilities as a reward for spending less for indirect care expenditures, had a negative relationship with quality for both sectors. A second incentive payment, paid to facilities as a reward for reducing capital spending, had no relationship with quality for either sector. The only relationship to result in a clinical significance between NFPs and FPs was the relationship between the indirect care incentive payment and case-mix adjusted RN nurse staffing with NFPs having a stronger negative relationship with this payment than FPs. The variation in direction between Medicaid reimbursement and quality highlights the importance of considering rate components rather than the average total rate. The fact that profit status did not moderate the relationship may reassure those who think that profit status affects quality. |
