A Longitudinal Study of Medicaid Payment, Private-Pay Price and Nursing Home Quality

  • David C. Grabowski

DOI: 10.1023/B:IHFE.0000019258.29496.03

Cite this article as:
Grabowski, D.C. International Journal of Health Care Finance and Economics (2004) 4: 5. doi:10.1023/B:IHFE.0000019258.29496.03


Quality of care problems have persisted for decades within U.S. nursing homes. A potential state-level policy towards addressing this concern is the level of Medicaid payment. However, a number of studies have found that an increase in Medicaid payment is associated with lower quality in the presence of certificate-of-need (CON) laws and bed construction moratorium regulations, which serve as barriers to entry within the nursing home industry. Instead of relying on potentially confounded cross-sectional comparisons, this study presents novel, panel-based evidence that incorporates aggregate private-pay price data. These estimates almost uniformly indicate that an increase in the Medicaid payment rate raises nursing home quality. When compared to the earlier literature, these new findings are attributed to changes over time in the market for nursing home care related to the growth in nursing home substitutes.

quality nursing homes Medicaid regulation 

Copyright information

© Kluwer Academic Publishers 2004

Authors and Affiliations

  • David C. Grabowski
    • 1
  1. 1.Department of Health Care Organization and PolicySchool of Public Health, University of Alabama at BirminghamUSA

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