BACKGROUND: Recent national legislation, reforms and regulations of the nursing home sector has shown increased focus on quality of care. The tendencies have also been present in the City of Oslo, where a relatively comprehensive quality measurement system has been implemented. Oslo has three different operating structures in the nursing home sector; public, private and nonprofit. All nursing homes have been subjects to the same measurement system regardless of operating structure. The measured quality has shown variations across the nursing homes. The City of Oslo has produced cost reports which also show variations.
OBJECTIVE: The objective has been to find out if the variations of costs and quality were reflected in the type of operating structure. The study question has been; do operating structures have an effect on cost per bed and measured quality?
METHOD: Results from cost reports, quality measurements and operating structures were arranged into a panel data set for the period 2007 to 2009. Fixed and random effects models were constructed. Different quality results and cost per bed served as dependent variables and operating structure was the independent variable. A Hausman test concluded that the random effects model was consistent and efficient. The main hypothesis was: measured quality and costs per bed are not affected by operating structure.
RESULT: Private nursing homes had a significantly lower cost per bed compared to public and nonprofit, controlled for time effects. The significance level was 1%. Only one quality measurement, relative survey score, showed significant differences among the operating structures. The nonprofit nursing homes had a significantly higher score compared to public and private, this was on the 1% significance level.
CONCLUTION: Results suggested that operating structure might have an effect on costs and parts of the measured quality, solely the relative survey score. It is possible that less pension costs might be the reason for lower costs of private nursing homes. It is also possible that the status and reputation of nonprofit nursing homes results in a higher score among the patients relatives. A closer study of the quality results and cost reports is necessary to make further conclusions.