The effect of facility type on quality in Medicaid's Intermediate Care Facility Program for the mentally retarded.

摘要

This study examined two groups of Intermediate Care Facilities for the Mentally Retarded that served Developmentally Disabled beneficiaries of the Medicaid program. One group of facilities was the private nonprofit ICFs/MR. For the purpose of this study, this group was characterized as those "organizations barred from distributing profits to owners or directors of the firm." The second group of organizations in this study included the private for-profit facilities. These organizations were motivated to pursue the goal of profit maximization. This study was undertaken to assess whether there are compelling reasons for continuing public policies that are supportive of a strong presence of nonprofits in this industry.; To assess ownership-related quality differences in the ICF/MR program, this study used a nationally representative sample of data on Medicaid certified facilities from the Health Care Financing Administration's On-line Survey and Certification Reporting System.; Based on the literature it was hypothesized that small facilities (those with 15 or fewer residents) would offer better quality than large facilities (those with 16 or more residents). Facilities with a more intense case-mix (those having more than 67% of their residents categorized with severe/profound mental retardation) are expected to require more resources to provide the same level of quality as those with a less intense case-mix.; The focus of the study was to assess ownership-related differences in quality. Insights from the economic theories of nonprofit organizations (Hannsman, 1980; Weisbrod, 1988) were used to develop the research question for this study. These theories emphasize the role of nonprofit organizations as an alternative to for-profit firms for producing goods and services when consumers are likely to be uninformed and vulnerable--or otherwise subject to exploitation. Nonprofit organizations are predicted to be more trustworthy by consumers, because they are restricted from distributing profits to owners, managers, or trustees.; Eight hypotheses were tested using a series of three-way ANOVAs to address the research question. The expectation was to find higher quality of care among the nonprofit ICF/MR facilities. The factorial analyses is more rigorous than either a statistically descriptive comparison or the one-way ANOVA design because it allows for the simultaneous analysis of the independent variables and their interactive effects on one another as well as the impact on the dependent variables. Before discussing the results of the three-way ANOVA tests, the descriptive and one-way ANOVA results will be presented.; The fundamental question of this study is "relative to the care delivered in nonprofit institutions, what effect does the profit motive have on the quality of care in the ICF/MR industry?" (Abstract shortened by UMI.)