Does Competition Improve Service Quality? The Case of Nursing Homes Where Public and Private Payers Coexist

2021 ◽  
Author(s):  
Susan Feng Lu ◽  
Konstantinos Serfes ◽  
Gerard Wedig ◽  
Bingxiao Wu
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Service Quality ◽  
Repeated Game ◽  
Healthcare Management ◽  
Quality Improvements ◽  
Rent Extraction ◽  
Public And Private ◽  
Market Structures ◽  
Wide Range

Competition plays an ambiguous role in nursing home markets where public and private payers coexist. Using U.S. nursing home data with a wide range of market structures, we find a U-shaped relationship between competition and service quality when nursing homes serve a mix of public and private segments, and a monotonically increasing relationship when nursing homes mostly serve the public, price-regulated, segment. The outcomes can be explained by the interplay of two opposing effects of competition: the reputation-building effect, whereby competing firms choose high quality to build a good reputation, and the rent-extraction effect, whereby competition hinders investment for quality improvements by lowering price premia. These observations are consistent with a repeated game model that incorporates public and private-payer segments. This paper was accepted by Stefan Scholtes, healthcare management.

What makes a nursing home a home? Insights from family members and friends

2017 ◽  
Vol 20 (4) ◽  
pp. 152-163 ◽  
Author(s):  
Lori Weeks ◽  
Stephanie Chamberlain ◽  
Janice Keefe
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Survey Data ◽  
Family Members ◽  
Nursing Home Residents ◽  
Models Of Care ◽  
Decision Makers ◽  
Public And Private ◽  
Content Type ◽  
Physical Spaces

Purpose The purpose of this paper is to explore the concept of homelikeness from the perspective of family members and friends of nursing home residents across different models of nursing homes. Design/methodology/approach This mixed-methods study examined survey data collected from 397 family members and friends of residents living in 23 nursing homes representing three models of care (traditional, new augmented, and full scope). Participants completed a homelikeness scale and a measure of the importance of nursing home spaces to family members and friends. This study also involved conducting three focus groups with 20 family members and friends to provide further insights into the findings. Findings Analysis of survey data indicated quite high levels of homelikeness overall. Significant differences did emerge between traditional model nursing homes compared to new full-scope and new augmented models for all items in the homelikeness scale and for many items about nursing home spaces. Qualitative results provided insights into how homelikeness can be fostered through public and private spaces and through care and relationships. Research limitations/implications As this study was conducted in one Canadian province, the results may not be applicable to other geographic areas. In addition, there are limitations in survey response rate. Practical implications Homelikeness can be supported across models of care by fostering relationships between residents and staff, ensuring that that family and friends feel welcome, and creating public and private physical spaces that are conducive to new and ongoing relationships. Originality/value The results provide evidence to nursing home decision makers about how to foster a homelike environment in various models of nursing homes.

scholarly journals An evaluation of telehealth expansion in U.S. nursing homes

2020 ◽  
Author(s):  
Gregory L Alexander ◽  
Kimberly R Powell ◽  
Chelsea B Deroche
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Organizational Characteristics ◽  
Limited Resources ◽  
Protective Equipment ◽  
Resident Evaluation ◽  
Significant Relationships ◽  
Wide Range ◽  
Home Telehealth ◽  
Score Range

Abstract Objective This research brief contains results from a national survey about telehealth use reported in a random sample of U.S. nursing homes. Methods and Materials The sample includes nursing homes (N = 664) that completed surveys about information technology maturity, including telehealth use, beginning January 1, 2019, and ending August 4, 2020. A pre/post design was employed to examine differences in nursing home telehealth use for nursing homes completing surveys prior to and after telehealth expansion, on March 6, 2020. We calculated a cumulative telehealth score using survey data from 6 questions about extent of nursing home telehealth use (score range 0-42). We calculated proportions of nursing homes using telehealth and used logistic regression to look for differences in nursing homes based on organizational characteristics and odds ratios. Results Significant relationships were found between nursing home characteristics and telehealth use, and specifically, larger metropolitan homes reported greater telehealth use. Ownership had little effect on telehealth use. Nursing homes postexpansion used telehealth applications for resident evaluation 11.24 times more (P < .01) than did nursing homes pre-expansion. Discussion Administrators completing our survey reported a wide range of telehealth use, including approximately 16% having no telehealth use and 5% having the maximum amount of telehealth use. Mean telehealth use scores reported by the majority of these nursing homes is on the lower end of the range. Conclusions One solution for the current pandemic is to encourage the proliferation of telehealth with continued relaxed regulations, which can reduce isolation and preserve limited resources (eg, personal protective equipment) while maintaining proper distancing parameters.

How to avoid and prevent coercion in nursing homes

2013 ◽  
Vol 20 (6) ◽  
pp. 632-644 ◽  
Author(s):  
Elisabeth Gjerberg ◽  
Marit Helene Hem ◽  
Reidun Førde ◽  
Reidar Pedersen
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Focus Group Interviews ◽  
Alternative Strategies ◽  
Nursing Home Staff ◽  
Alternative Interventions ◽  
Persuasive Strategies ◽  
Organization Of Care ◽  
Wide Range ◽  
Group Interviews

In many Western countries, studies have demonstrated extensive use of coercion in nursing homes, especially towards patients suffering from dementia. This article examines what kinds of strategies or alternative interventions nursing staff in Norway used when patients resist care and treatment and what conditions the staff considered as necessary to succeed in avoiding the use of coercion. The data are based on interdisciplinary focus group interviews with nursing home staff. The study revealed that the nursing home staff usually spent a lot of time trying a wide range of approaches to avoid the use of coercion. The most common strategies were deflecting and persuasive strategies, limiting choices by conscious use of language, different kinds of flexibility and one-to-one care. According to the staff, their opportunities to use alternative strategies effectively are greatly affected by the nursing home’s resources, by the organization of care and by the staff’s competence.

scholarly journals An Integrated Approach for Prioritizing Key Factors in Improving the Service Quality of Nursing Homes

2013 ◽  
Vol 2013 ◽  
pp. 1-12 ◽  
Author(s):  
Vincent F. Yu ◽  
Kuo-Jen Hu
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Service Quality ◽  
Home Care ◽  
Integrated Approach ◽  
Nursing Home Care ◽  
Key Factors ◽  
Interpretive Structural Modeling ◽  
Quality Of Nursing

This study looks at improving the service quality in nursing homes as well as the intricate relationships between various factors. We use two research models herein. First, Interpretive Structural Modeling (ISM) establishes the criteria for the interrelationship structure, categorized according to their driving power and dependence. This methodology provides a means by which order can be imposed on the complexity of such criteria. Insights from this model can help top managers in strategic planning to improve the service quality in nursing home care. Second, because ISM does not provide any weighting associated with the criteria, we employ the Analytic Network Process (ANP) approach to calculate the weighted importance of the key factors and to identify those factors impacting the service quality of nursing home care.

Does Nonprofit Ownership Matter for Firm Performance? Financial Distress and Ownership Conversion of Nursing Homes

2021 ◽  
Author(s):  
Lauren Xiaoyuan Lu ◽  
Susan Feng Lu
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Financial Performance ◽  
Financial Distress ◽  
Cost Reduction ◽  
Registered Nurse ◽  
Nurse Staffing ◽  
Healthcare Management ◽  
Operating Costs ◽  
Operating Efficiency

In the past two decades, many nursing homes converted their ownership status from nonprofit to for-profit (NP-to-FP). These conversions have drawn public scrutiny and triggered a debate about the implications of ownership conversions on nursing home performance. Exploring a nationwide panel data set of U.S. nursing homes from 2006 to 2017, we observe that nursing homes with higher financial distress are associated with higher likelihood of NP-to-FP conversions. The postconversion operating margins increased significantly. Converted nursing homes improved their financial performance by reducing operating costs while keeping net resident revenues unchanged. Both cutting registered nurse staffing and cutting overhead staffing contributed to reductions in operating costs; however, only the former cost-reduction measure had a negative impact on quality. On average, the postconversion quality of care declined. The effects of NP-to-FP conversions on nursing homes were moderated by preconversion financial distress: High-distress nursing homes aggressively cut registered nurse staffing and experienced severe quality decline, whereas low-distress ones kept registered nurse staffing unchanged and largely avoided quality decline. These findings lead to both policy and managerial insights. To nursing home regulators, we recommend increased oversight on NP-to-FP conversions of nursing homes with high preconversion financial distress. To managers of nursing homes undergoing NP-to-FP conversions, our findings suggest that although cost reduction is an effective strategy to improve financial performance, they need to avoid the pitfall of cutting registered nurse staffing and instead focus on streamlining overhead operations in order to increase operating efficiency without compromising quality. This paper was accepted by Stefan Scholtes, healthcare management.

Quality in Nursing Homes

2019 ◽  
Author(s):  
Matteo Lippi Bruni ◽  
Irene Mammi ◽  
Rossella Verzulli
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Developed Countries ◽  
Poor Quality ◽  
Nursing Home Care ◽  
Future Research ◽  
Term Care ◽  
Nursing Home Quality ◽  
Wide Range ◽  
The Impact

In developed countries, the role of public authorities as financing bodies and regulators of the long-term care sector is pervasive and calls for well-planned and informed policy actions. Poor quality in nursing homes has been a recurrent concern at least since the 1980s and has triggered a heated policy and scholarly debate. The economic literature on nursing home quality has thoroughly investigated the impact of regulatory interventions and of market characteristics on an array of input-, process-, and outcome-based quality measures. Most existing studies refer to the U.S. context, even though important insights can be drawn also from the smaller set of works that covers European countries. The major contribution of health economics to the empirical analysis of the nursing home industry is represented by the introduction of important methodological advances applying rigorous policy evaluation techniques with the purpose of properly identifying the causal effects of interest. In addition, the increased availability of rich datasets covering either process or outcome measures has allowed to investigate changes in nursing home quality properly accounting for its multidimensional features. The use of up-to-date econometric methods that, in most cases, exploit policy shocks and longitudinal data has given researchers the possibility to achieve a causal identification and an accurate quantification of the impact of a wide range of policy initiatives, including the introduction of nurse staffing thresholds, price regulation, and public reporting of quality indicators. This has helped to counteract part of the contradictory evidence highlighted by the strand of works based on more descriptive evidence. Possible lines for future research can be identified in further exploration of the consequences of policy interventions in terms of equity and accessibility to nursing home care.

Tingkat Kepuasan Nasabah Pada Bank Syariah Mandiri Cabang Bogor

2019 ◽  
Vol 4 (2) ◽  
pp. 34
Author(s):  
Priyo Wismantoro ◽  
Fika Dwiyanti
Keyword(s):  
Quality Of Service ◽  
Customer Satisfaction ◽  
Service Quality ◽  
Competitive Advantage ◽  
Customer Service ◽  
General Level ◽  
Customer Focus ◽  
Quality Improvements ◽  
Level Of Satisfaction

Business banking is a service business based on principles of trust and t5he customer is a major asset. Under conditions of business competition among banks strict bank that has resulted in only a competitive advantage (compatative advantage as well as a competitive advantage) who can reach the highest position in the eyes of cusmers or the public. Competitive advantage can be obtained from the quality of customer servicr, so the focus on customers (customer focus), responsive to the development of customer desires and continuously innovate is an acitivity that can be done to anticipate the cimpetitive conditions. In this case, the bank should always evaluate the quality of service given to customers and is reflected in the level of customer satisfaction obtained. Rate the quality of service branch of bank syariah mandiri bogor whole is still under service, because it still was below expectations, this is evident also that the general level of service is still not meeting customer expectations, because the level of hope (expectation0 the customer is generally higher than the level of performance (perfromance) or perception(perception)customer.        Empathy dimension of service quality dimensions are most critical or have any impact on the most powerful influence on the level of satisfaction. In this case, the willingness og bank syariah mandiri branch bogor provide individual attention in serving its clients is crucial. Empathy dimension attributes inclide individual attention, operational time , personal attention, giving interests, and understand the needs. These attributes is the main priority of service quality improvements are intensive and comprehensive.           Customer service strategy to be implemented by the management of bank syariah mandiri in perspective five dimensioris of service quality(tangibles, realiability,responsiveness, assurance and empathy) looks not optimal. In an effort to provide the best service (service excellence) and focus to the customer(customer focus), then the customer satisfaction can be obatained with significantly improved and the improvement of quality of serivice aspects and impticalions of the strategy need to be consldered

Empirical Study On Attributes Leading To Satisfaction Among Bank Customer

2019 ◽  
Vol 118 (7) ◽  
pp. 101-110
Author(s):  
Ms.U.Sakthi Veeralakshmi ◽  
Dr.G. Venkatesan
Keyword(s):  
Service Quality ◽  
Behavioral Intention ◽  
Banking Sector ◽  
Positive Impact ◽  
Quality Performance ◽  
Public And Private ◽  
The Difference ◽  
The Individual ◽  
Private Banking ◽  
Service Gap

This research aims at measuring the service quality in public and private banking sector and identifying its relationship to customer satisfaction and behavioral intention. The study was conducted among 500 bank customers by using revised SERVQUAL instrument with 26 items. Behavioral intention of the customers was measured by using the behavioral intention battery. The researcher has used a seven point likert scaling to measure the expected and perceived service quality (performance) and the behavioral intention of the customer. The instrument was selected as the most reliable device to measure the difference-score conceptualization. It is used to evaluate service gap between expectation and perception of service quality. Modifications are made on the SERVQUAL instrument to make it specific to the Banking sector. Questions were added to the instrument like Seating space for waiting (Tangibility), Parking space in the Bank (Tangibility), Variety of products / schemes available (Tangibility), Banks sincere steps to handling Grievances of the customers (Responsiveness). The findings of the study revealed that the customer’s perception (performance) is lower than expectation of the service quality rendered by banks. Responsiveness and Assurance SQ dimensions were the most important dimensions in service quality scored less SQ gap. The study concluded that the individual service quality dimensions have a positive impact on Overall Satisfaction.

SERVICE QUALITY OF PUBLIC AND PRIVATE PHYSIOTHERAPY INSTITUTES: A COMPARATIVE STUDY IN LAHORE

2019 ◽  
Author(s):  
Roohi Abbas
Keyword(s):  
Physical Therapy ◽  
Service Quality ◽  
Cross Sectional Study ◽  
Quality Of Services ◽  
Sectional Study ◽  
Cross Sectional ◽  
Public And Private ◽  
Quality Dimensions ◽  
Service Quality Dimensions

Background: Ever since quality of services is gaining importance in every industry as it is the indicator of consumer/customer satisfaction, it is of utmost importance to measure service quality of educational institutes to determine the satisfaction of students. Thus, the study aimed to determine the important factors in service quality dimensions which contribute to the satisfaction of students. Methods: This was a Comparative Cross Sectional study in which final year department of physical therapy (DPT) students were included from three private and three public physiotherapy institutes. Results: The largest mean Positive Gap scores for Public Physiotherapy Institutes was 0.18 for accessibility and affordability 0.18. The largest negative mean gap score for Private Physiotherapy domain was “Accessibility and Affordability” found to be -1.96. Conclusion: Students were satisfied with service quality of private institutes in all domains except for the “Accessibility and Affordability” whereas, in Public Institutes largest negative quality gaps were found in “Empathy” and “Assurance”.

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