In light of persistent shortcomings in nursing home care quality and evidence that lower nurse staffing levels could be harmful to residents, we examine whether staffing levels are affected by changes in Medicare reimbursement rates. We exploit a 2006 change in Medicare’s methodology for adjusting provider payments for geographic differences in costs, a change that generated plausibly exogenous variation in nursing facility reimbursement rates. Our method compares facilities with higher and lower shares of Medicare resident days, which were differentially exposed to the payment changes we examine. Using panel data on US nursing homes from 2003 through 2009, we find that higher Medicare payments increased nurse staffing hours per resident day. Additional results suggest that changes in Medicare payments did not affect other measures of quality.

中文翻译：

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医疗保险支付变更对疗养院人员编制的影响

鉴于养老院护理质量的持续缺陷以及有证据表明较低的护士人员配备水平可能对居民有害，我们研究了人员配备水平是否受到Medicare报销率变化的影响。我们利用2006年Medicare的方法变化来调整服务提供商的付款，以适应成本的地域差异，这种变化可能导致护理机构报销率的外生变化。我们的方法比较了医疗保险居民天数所占比例较高和较低的设施，这些设施在我们检查的付款变化中存在差异。使用2003年至2009年美国养老院的面板数据，我们发现更高的Medicare付款增加了每个居民日的护士工作时间。其他结果表明，医疗保险付款的变化不会影响其他质量指标。