Document Type

Working Paper




nursing home, Medicare, Medicaid, long-term care, social welfare




Health Policy


Just as managed care has changed utilization and incentives in other parts of health care, there is a whole set of incentives built around long-term care that really matter. For example, if nursing homes have a financial incentive to hospitalize people with certain health conditions, then in the long run they are not going to develop the programs and invest in the resources to treat those people in the facility. Instead they're going to use those resources to stay in business or to provide other types of care. And while we can assume that policymakers do not create regulations that they expect will lead to poor quality, efforts to increase access or efficiency sometimes have the unintended consequence of reducing quality. Health care sectors in which spending is rising particularly rapidly or in which access seems to be problematic may be prone to regulations that fail to take into account potential effects on quality. There's a lot of money spent on nursing homes; there's certainly a lot of interest from public funders in nursing homes; and nursing homes have a long history of quality-of-care problems. Not surprisingly, then, some of the most interesting sets of bad incentives for quality can be found in nursing homes.


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