| Objective. To study whether nursing homes operating in competitive environments have higher quality.; Data sources. Nursing Home Compare data, the 2000 Census data, the 2005 Tiger map data from the Census Bureau, the 2004 Online Survey, Certification, and Reporting (OSCAR) data and Area Resource File (ARF).; Method. 16,011 nursing homes covered in the Nursing Home Compare data were analyzed. The dependent variables are staffing hours, deficiencies, quality measure score, and total score respectively. The key independent variable is the Hirschman-Herfindahl Index (HHI), average distance to five nearest nursing homes and predicted average occupancy of other nursing homes in the county. Control variables include nursing home and area characteristics. Fixed effect and multilevel regressions were run.; Findings. Nursing homes in counties with smaller HHI or closer to competitors have more staffing hours, fewer deficiencies, higher quality measure scores and higher total scores. Predicted average occupancy of other nursing homes in the county is not significantly related with quality in general, the reason may be that it does not have sufficient variation.; Conclusion. Nursing homes operating in more competitive environments have higher quality of care.; Key words. Nursing home, competition, quality, Hirschman-Herfindahl Index (HHI), staffing, deficiencies, Geographic Information System (GIS), MLwiN. |
