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Administrative Data Systems

7. Illustrations

The Effect of Policies and Markets on Providers and Residents’ Outcomes

Since 1999 investigators at Brown University have linked data acquired via surveys of Medicaid officials and reviews of state web sites to facility-level information that summarizes state and federal inspections of nursing homes and resident-level MDS and Medicare claims records. Their aim is to test the effect of changes in state Medicaid policies on the strategic management choices nursing facility administrators make and how those decisions ultimately affect the lives of the residents served (Mor, Zinn et al., 2007Grabowski, Feng et al., 2008; ZInn, Feng et al., 2008). This framework motivated a National Institute on Aging-funded Program Project that is now extending these data for more than a decade and linking this information with a specially designed survey of a large random sample of nursing homes.  Figure 3 below shows a heuristic that motivates this research, which is made possible precisely by linking individual and health service utilization event-level data for a defined population to information about the providers of care, and the state policy and market contexts in which they operate.

These data permit rigorous testing of states’ policies’ impact by taking advantage of the “natural experiments” operating in states around the country. Since federal Medicare policies governing payment of nursing homes and home health providers have also changed over the observation, it is also possible to compare changes in federal policies with related state-based Medicaid policy changes, thereby better informing our understanding of the impact of federal policy changes.

Figure 3

Figure illustrating conceptual model of policies and market effects on providers as discussed in text