Nursing Homes Quality

Why don’t patients care about quality?

For nursing homes at least, patients do not seem to have much choice.  According to an article by Grabowski and Town:

The introduction of the NHQI was generally unrelated to facility quality and consumer demand. However, nursing homes facing greater competition improved their quality more than facilities in less competitive markets…The lack of competition in many nursing home markets may help to explain why the NHQI report card effort had a minimal effect on nursing home quality. With the introduction of market-based reforms such as report cards, this result suggests policy makers must also consider market structure in efforts to improve nursing home performance.

In general, there are many reasons why patients do not respond to provider report cards.  It could be the case that the provider is a monopoly, and thus the patient has little choice of providers.  Alternatively, patients may not be aware of the quality metrics.  One would thing that high quality providers, however, would spend money advertising their high quality ratings to make patients aware of their services.  In other cases, the patients may not be the ones directing care choices.  Providers may be the ones who are the de facto selectors of care.

Patients could also not believe that the CMS quality ratings are very useful.  They may prefer other sources of information on medical quality such as their friends, relatives, or physicians.  Thus, it may be the physician who actually chooses to which nursing home the patient will go.  If the physician has incentives to sent the beneficiary to nursing homes in the network or simply does not wish to spend the time analyzing nursing home quality, then patients may be less likely to be allocated to high quality nursing home.




  1. People don’t know about the Medicare operated web site
    where they can see the ratings. Often choices are offered by hospital discharge planners, who may chose the nursing homes whose name they remember, instead of the one with the best rating.
    When people enter a nursing home for “rehab,” they don’t expect to spend the rest of their lives there, so aren’t as careful as they might be in choosing the facility. And facilities often refuse to accept a person who is not satisfied with the facility where they currently reside. So a person is “stuck.” A long-term care Ombudsman can often help.

  2. I’m sure it’s just a lack of information. Not to mention a lack of trust in that information.

    The odd thing is that you’re probably right that we trust our friends and family more than we do some government website. Yet, what basis do our friends and family have for really knowing how good the quality of the care the received really is?

Leave a Reply

Your email address will not be published. Required fields are marked *