Government Regulation and the Quality of Healthcare

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1、GovernmentRegulationandtheQualityofHealthcareEvidencefromMinimumStaffingLegislationforNursingHomesJordanD.MatsudairaABSTRACTThispaperinvestigatestheeffectofaregulationmandatingaminimumnurse-staffinglevelonthequalityofhealthcareinnursinghomes.Tocomplywiththeregulation,firmsi

2、ncreaseemploymentofnursesinproportiontothegapbetweentheirinitialstaffinglevelandthelegislatedminimumthreshold.Ifhighernursestaffingcausesbetterquality,thenthechangesinqualityoutcomesshouldmirrorthesechanges.Despiteinducingincreasesinnurseaidehoursof10percentonaverageandupt

3、o30percentforsomefirms,Ifindnoimpactoftheregulationonpatientoutcomesoroverallfacilityquality.I.IntroductionIn2000,theInstituteofMedicinereportedthatnearly100,000Ameri-cansdieeachyearduetomedicalerrorsinhospitalsettings(NationalAcademyPress[NAP]2000).AreportbytheU.S.Governm

4、entAccountingOffice(GAO)foundthat29percentoflong-termcarefacilitieswerecitedforsafetyandcareviolationsthatcausedactualharmorimmediatejeopardytotheirresidentsinmid-2000(GAO2003),reinforcingconcernsoverqualityofcareinthatindustrydocumentedsincelongbe-fore(NAP2001).Inrespons

5、etothisperceivedcrisisinthequalityofhealthcare,policymakershaverespondedwithcallsforincreasesinthelevelofnursestaffinginallhealthcaresettings.Californiawasfirsttoadoptminimumnurse-patientstaff-JordanD.MatsudairaisanassistantprofessorintheDepartmentofPolicyAnalysisandManage

6、mentatCornellUniversity.HethanksDamonClark,HeatherRoyer,andseminarparticipantsatRANDforhelpfulcomments.HeisgratefulforgrantsfromtheCornellPopulationProgramandtheNationalScienceFoun-dation(SES-0850606),andtotheRobertWoodJohnsonFoundation’sScholarinHealthPolicyProgramforsu

7、pportingtheearlystagesofthiswork.MargaretJonesprovidedexcellentresearchassistance.ThedatausedinthisarticlecanbeobtainedbeginningAugust2014throughJuly2017fromtheauthoratjdm296@cornell.edu.[SubmittedAugust2011;acceptedDecember2012]ISSN0022-166XE-ISSN1548-8004©2014bytheBoar

8、dofRegentsoftheUniversityofWisconsinSystemTHEJOURNALOFHUMANRESOURCES•49•1Matsudaira33inglegislationforh