Table 3.
Stage 1—OLS Reduced-Form Equations: Medicaid Rates, Resident Case Mix, RN Hours, and Total Nursing Hours (Coefficients with Standard Error in Parentheses)
| Exogenous Factors | State Average Medicaid Reimbursement Rate | Resident Case Mix | RN Hours | Total Nursing Hours | RN Hours without Instrumental Variables*** | Total Hours without Instrumental Variables*** |
|---|---|---|---|---|---|---|
| Facility resources | ||||||
| RN pay rate per hour | 5.890** | 0.055** | 0.001 | 0.039** | −0.003 | 0.053** |
| (0.101) | (0.006) | (0.004) | (0.008) | (0.004) | (0.008) | |
| Proportion Medicaid residents | 0.014* | −0.0002 | −0.003** | −0.005** | −0.003** | −0.005** |
| (0.005) | (0.0003) | (0.0002) | (0.0004) | (0.0002) | (0.0004) | |
| Medicaid case-mix reimbursement | 3.932** | 0.008 | 0.016 | −0.150** | 0.008 | −0.134** |
| (0.261) | (0.015) | (0.011) | (0.021) | (0.010) | (0.020) | |
| Medicaid prospective reimbursement method | −15.936** | −0.060** | −0.044** | −0.110** | ||
| (0.251) | (0.014) | (0.010) | (0.020) | |||
| State RN minimum | 28.978** | 0.111** | 0.247** | 0.562** | 0.232** | 0.703** |
| Staffing standard | (0.726) | (0.041) | (0.029) | (0.057) | (0.028) | (0.054) |
| Medicare SNF | −0.105** | −0.007** | 0.001* | −0.002** | 0.001** | −0.005** |
| Reimbursement rate | (0.009) | (0.001) | (0.0004) | (0.001) | (0.0003) | (0.001) |
| Facility characteristics | ||||||
| For-profit facility | −1.588** | −0.067** | −0.147** | −0.358** | −0.148** | −0.359** |
| (0.219) | (0.012) | (0.009) | (0.017) | (0.009) | (0.017) | |
| Multifacility system | −1.714** | −0.005 | −0.008 | −0.132** | −0.007 | −0.134** |
| Member | (0.198) | (0.011) | (0.008) | (0.016) | (0.008) | (0.016) |
| Hospital-based | 0.186 | 0.010 | 0.024 | 0.054* | 0.024 | 0.058* |
| (0.316) | (0.018) | (0.013) | (0.025) | (0.013) | (0.025) | |
| Number of facility beds | 0.010** | 0.0001 | −0.001** | −0.001** | −0.001** | −0.001** |
| (0.002) | (0.0001) | (0.0001) | (0.0001) | (0.0001) | (0.0001) | |
| Dual/distinct part | 1.917** | 0.266** | 0.099** | 0.201** | 0.100** | 0.219** |
| Certification | (0.332) | (0.019) | (0.014) | (0.026) | (0.013) | (0.027) |
| SNF certification | 0.158* | −0.080* | 1.937** | 2.911** | 1.939** | 2.927** |
| (0.627) | (0.035) | (0.025) | (0.050) | (0.025) | (0.050) | |
| County demographic economic variables | ||||||
| Proportion aged 65 and older | 2.941** | −0.038** | 0.002 | 0.024** | 0.006* | 0.020** |
| (0.070) | (0.004) | (0.003) | (0.006) | (0.003) | (0.005) | |
| Percentage females in labor force | −0.682** | −0.014** | −0.001 | −0.007** | −0.0002 | −0.003 |
| (0.035) | (0.002) | (0.001) | (0.003) | (0.001) | (0.003) | |
| Personal income per capita | 1.661** | −0.009** | 0.015** | −0.002 | 0.017** | −0.001 |
| (0.053) | (0.003) | (0.002) | (0.004) | (0.002) | (0.004) | |
| Percent metropolitan | −0.338** | 0.003** | −0.003** | −0.005** | −0.004** | −0.003** |
| Population | (0.012) | (0.001) | (0.001) | (0.001) | (0.001) | (0.001) |
| Political variables | ||||||
| Democratic governor | −6.647** | 0.085** | 0.025** | −0.129** | ||
| (0.235) | (0.013) | (0.010) | (0.018) | |||
| Political party split | −4.455** | −0.200** | 0.022* | 0.050* | 0.021* | −0.018 |
| (0.270) | (0.015) | (0.011) | (0.021) | (0.010) | (0.020) | |
| Market factors | ||||||
| NF Herfindahl (facility concentration) | 0.279 | −0.134** | −0.045* | −0.059 | −0.042* | −0.051 |
| (0.469) | (0.026) | (0.019) | (0.037) | (0.019) | (0.037) | |
| Percent excess NF beds in the county | −0.062** | −0.003** | 0.001 | 0.007** | 0.001 | 0.006** |
| (0.014) | (0.001) | (0.001) | (0.001) | (0.001) | (0.001) | |
| Nursing home beds per 1,000 age 65+ | −0.094** | −0.011** | −0.002** | −0.014** | −0.003** | −0.014** |
| (0.011) | (0.001) | (0.0004) | (0.001) | (0.0004) | (0.001) | |
| Hospital beds per 1,000 population | −0.037 | 0.0001 | 0.002 | 0.007* | 0.001 | 0.008** |
| (0.038) | (0.002) | (0.002) | (0.003) | (0.002) | (0.003) | |
| Intercept | −12.609** | 8.249** | 0.340** | 4.699** | 0.363** | 4.804** |
| (2.561) | (0.144) | (0.104) | (0.202) | (0.104) | (0.202) | |
| R2 | 0.771** | 0.162** | 0.560** | 0.477** | 0.559** | 0.474** |
| Mean= | 117.16 | 5.82 | 0.66 | 3.62 | 0.66 | 3.62 |
| N = 14,256; df = | 22 | 22 | 22 | 22 | 20 | 20 |
Shaded areas show omitted variables from the model.
*
Significant at the .05 level.
**
Significant at the .01 level.
***
Instrumental variables are excluded from the OLS regression.
RN, registered nurse; SNF, skilled nursing care; NF, nursing facility.