The determinants of nursing home costs in Nebraska's proprietary nursing homes.

In the past few years nursing home care expenditures in Nebraska and the U.S. have been the fastest growing component of total health care expenditures. This rate of increase is particularly alarming in view of the fact that nursing home care is financed primarily by the Medicaid program or direct out-of-pocket payments. In fact, given the cutbacks in federal and state funds for this program, consumers will be forced to allocate a larger share of their income to meet the costs of nursing home care. Although nursing home expenditures have grown at an extremely rapid rate, relatively few empirical studies exist which analyze the cost function of nursing home providers. The purpose of this study is to identify factors which have directly influenced the cost of nursing home care in Nebraska and to evaluate the current Nebraska Medicaid reimbursement system in terms of its impact upon nursing home costs. The study was limited to a sample of 40 nursing homes in Nebraska which represents 42% of the total proprietary nursing homes in the state. The sample was limited to those facilities licensed only as an Intermediate Care Facility--I and they had to be receiving some Medicaid revenue. The data were averaged over the period of 1977-79, but the year of analysis corresponded to 1978. Multiple regression analysis was used to measure the effect of the hypothesized independent variables upon two different measures of cost--the average total cost per patient day and the average variable cost per patient day. In the first regression model 76% of the variance was explained and 71% was explained in the second equation. The results of this analysis are basically consistent with the findings of other studies and indicate that the number of staffing hours, patient mix, facility age, administrator experience and administrative intensity are significant determinants of nursing home costs. The most important finding from a policy perspective is that the current retrospective cost-related Medicaid reimbursement system does not provide incentives for minimizing costs. In fact, the present system encourages administrators to overutilize resources and charge higher prices. Considerable evidence exists which suggests that a prospective system would encourage a more efficient allocation of resources without adversely affecting the quality of care. Given the increase in the state's share of the total Medicaid budget, it would appear that a change to a prospective system is critical in order to maintain the financial accessibility to nursing home care by all Nebraska residents.     

Peer‐group dependence in salary benchmarking: a statistical model

Although salary benchmarking is widely used to help set compensation, there has been a lack of attention to the statistical implications of this practice on compensation patterns of peer institutions. We adapt some empirical tools from spatial econometrics to analyze compensation decisions exhibiting peer‐group dependence, and apply the methods to compensation of administrators in Texas nursing facilities. We find evidence that this leads to dependence of administrators pay on average pay of administrators in ‘peer’ facilities, defined here as those having similar outlays on nursing services. This leads to a situation where changes in facility characteristics, such as the occupancy rate and the revenue received from Medicaid and from private‐pay residents, impact compensation of own‐institution administrators as well as that of administrators from other peer facilities. Our peer‐group model appears applicable to other areas of organizational, regulatory and behavioral research and can easily be implemented using publicly available software. Copyright © 2010 John Wiley & Sons, Ltd.     

Modeling returns to owner-occupied single-family residences

This paper expands previous models of the returns to owner-occupied single-family residences by modelling returns to a specific property of an individual homeowner instead of determining an average market return based on appraised values. Included in the model are transaction costs, degree of leverage, level of price appreciation, the implied rental cost in ownership, tax bracket, and duration of home ownership. Simulation results suggests that the level and timing of transaction costs are important to homeowners and rates of return to owner-occupied single-family residences increase to a point in time and thereafter decline.     

A priority assignment model for standards and conditions in a long term care survey

Presently a survey document is used in New York State to enforce Federal and State regulatory standards for long term care facilities (skilled nursing facilities and health related facilities). This document is used to establish Medicare and Medicaid certification for these facilities.

This study describes the creation of a new survey process—a first stage consisting of a screening survey followed, if necessary, by an intensive survey. A priority assignment model which utilizes the judgements of experts from the New York State Office of Health Systems Management (OHSM) has been developed. This model is employed to develop ranks, priority weights and classifications for the various standards and the Federal conditions which the standards comprise (as well as equivalent State regulations).

Saaty's Analytical Hierarchy Process is used to obtain the ranks and priority weights. The consistency of the experts' judgements is measured using Kendall's coefficient of agreement. An optimal split algorithm is used to subdivide the standards and conditions according to impact (high, moderate or low) on patient care, health and safety.

The results are to be used as a management tool in developing decision rules for defining the scope of the intensive survey on the basis of screening survey results.     

Autoverkopen en autopark in Nederland, 1950–1970

Summary  This is a study of the demand for the ownership of new or firsthand cars, i.e. the demand of 'first owners' who habitually buy new cars which are then traded in long before they are obsolescent. Upon combining the evidence of various surveys with time-series for 1950-64 it is found that this ownership has an income elasticity of 2 and a price elasticity of – 1.25 in respect of the constant-quality index of new car prices earlier provided. On the average new cars are traded in after three years so that roughly one third of the existing stock is replaced every year. These values together determine an equation for purchases of new cars which accurately predicts new registrations in 1965 and 1966. Projections for the years 1967-70 are provided.
In the model employed the total number of cars (including used cars) is determined by the active demand exerted by 'first owners' on one hand and by the hitherto fairly constant scrappage rates on the other. Projections of the overall ownership rate can therefore be derived from the forecasts of new registrations. The ownership rate will approach 80% around 1970, and it is likely that at that stage the current scrappage rates will cease to apply in view of the greater predilection for comparatively younger cars.     

Shareholder Loans and Earnings Smoothing – Empirical Findings from German Private Firms

This paper analyzes the interplay between shareholder loans and earnings smoothing in German private corporations. Shareholders who grant loans have a dual stakeholder role, being both equity holders and creditors. Those loans could be lost, because bankruptcy law requires their subordination in the event of bankruptcy. We therefore expect shareholder loans to mitigate agency problems of debt. This reduces the need for debt covenants and earnings smoothing. Moreover, the interest payments from shareholder loans tend to lower payout volatility which also reduces the need for dividend and earnings smoothing. We expect and find that private firms with shareholder loans exhibit significantly lower levels of earnings smoothing than other private firms. We find that with a 10 percentage-point increase in the shareholder loans to total assets ratio, earnings smoothing decreases by about 10% of the mean value. We also find that this substitution effect usually occurs in case of managerial ownership and tends to be slightly weaker in the event of dispersed ownership. The results are robust for different econometric specifications, including different measures of key variables and propensity score matching. The paper suggests that financial reporting by private firms responds to the dual stakeholder role of shareholder loans.     

The impact of positive property tax differentials on the timing of development

To date, few empirical studies have focused on the location decision by residential developers in response to changes in the property tax. Based on a dynamic time-to-development model by Turnbull, this paper finds, using 17 years of parcel level data from Saint Louis County, Missouri, that higher than average tax rates increase the time-to-development for vacant parcels by between 4 and 11%, all else equal. Additionally this paper finds that the tax differential effect is cumulative, resulting in about a 20% increase in the time-to-development for the parcel facing the average number of years with a higher than average rate. These results support the analytical results by both Turnbull [Turnbull, G.K., 1988. The effects of local taxes and public services on residential development patterns. Journal of Regional Science, 28 (4), 541–562.] and McMillen [McMillen, D.P., 1990. The timing and duration of development tax rate increases. Journal of Urban Economics, 28, 1–18.] that the property tax can distort residential capital markets leading to inefficient urban growth, or sprawl.     

A dymimic model of housing price determination

This paper presents and estimates a model of the resale housing market. The data are a cross-section of monthly time series obtained from the multiple-listing service for a suburb of San Diego. The model is specified and estimated as a dynamic multiple indicator multiple cause system of equations where the capitalization rate is taken to be an unobservable time series to be estimated jointly with the unknown parameters. These are estimated by maximum likelihood using an EM algorithm based upon Kalman filtering and smoothing.The specification of the model features hedonic equations for each house sale and a dynamic equation for the capitalization rate which is constrained to make the expectation of prices equal the present value of the net returns to home ownership whenever the economic variables stabilize at steady state values. Out of steady state, the capitalization rate slowly adapts to new information.The model attributes a large portion of housing price increases of the 1970's to a fall in the capitalization rate which in turn was driven by rental inflation, tax rates and mortgage rates. Post-sample simulations indicate an initial flattening of housing inflation rates and later a fall brought on by the increase in steady state capitalization rates. In-sample simulations show that although both Proposition 13 and the inflation induced rise in the marginal income tax rates provided partial explanations for the fall in capitalization rates, the single most important factor was the acceleration in price of housing services which interacted with the tax treatment of home ownership to produce an amazing 18% average annual rate of price increase over the last seven years of the 1970's.     

Creating an efficient market for nursing home care.

This paper reviews the theoretical foundations of the common Medicaid nursing home reimbursement systems: Reasonable cost related, fixed rate and negotiated rate reimbursement. Each reimbursement system is examined in terms of the four reimbursement system design goals: allocative efficiency, appropriateness of care, quality of care and equity of economic rewards. None of the reimbursement approaches are found to be deficient on the theoretical level, but practical problems of implementation are shown to be very difficult. As an alternative, a competitive binding system is proposed which would bring competitive market efficiency to the allocation of Medicaid funds for nursing home care. A mathematical programming model is developed to process the bidding information and to allocate Medicaid funds to nursing homes.     

Autoverkopen en autopark in Nederland, 1950–1970

Summary This is a study of the demand for the ownership of new or firsthand cars, i.e. the demand of ‘first owners’ who habitually buy new cars which are then traded in long before they are obsolescent. Upon combining the evidence of various surveys with time-series for 1950-64 it is found that this ownership has an income elasticity of 2 and a price elasticity of – 1.25 in respect of the constant-quality index of new car prices earlier provided. On the average new cars are traded in after three years so that roughly one third of the existing stock is replaced every year. These values together determine an equation for purchases of new cars which accurately predicts new registrations in 1965 and 1966. Projections for the years 1967-70 are provided. In the model employed the total number of cars (including used cars) is determined by the active demand exerted by ‘first owners’ on one hand and by the hitherto fairly constant scrappage rates on the other. Projections of the overall ownership rate can therefore be derived from the forecasts of new registrations. The ownership rate will approach 80% around 1970, and it is likely that at that stage the current scrappage rates will cease to apply in view of the greater predilection for comparatively younger cars.     

Technical efficiency in texas nursing facilities: A stochastic production frontier approach

A rapidly aging U. S. population is straining the resources available for long term care and increasing the urgency of efficient operations in nursing homes. The scope for productivity improvements can be examined by estimating a stochastic frontier production function. We apply the methods of maximum likelihood and quantile regression to a panel of Texas nursing facilities and infer that the average productivity shortfall due to avoidable technical inefficiency is at least 8 percent and perhaps as large as 20 percent. Non-profit facilities are notably less productive than comparable facilities operated for profit, and the industry has constant returns to scale.     

The effect of household appliances on female labor force participation: Evidence from microdata

We estimate the effect of household appliance ownership on the labor force participation rate of married women using micro-level data from the 1960 and 1970 U.S. Censuses. In order to identify the causal effect of home appliance ownership on married women's labor force participation rates, our empirical strategy exploits both time-series and cross-sectional variation in these two variables. To control for endogeneity, we instrument a married woman's ownership of an appliance by the average ownership rate for that appliance among single women living in the same U.S. state. Single women's labor force participation rates did not increase between 1960 and 1970. We find evidence in support of the hypothesis that the diffusion of household appliances contributed to the increase in married women's labor force participation rates during the 1960's.     

An integrative analysis of business bankruptcy in Australia

This paper proposes an integrative and dynamic approach for analyzing business failure. The simultaneous estimation results obtained with Australian data indicate significant associations between bankruptcy rates in different industries. Most of these associations are positive and hence implying that bankruptcy in one industry can inflict a ‘domino’ effect on other industries. The estimated significant negative association between current and lagged bankruptcy rates in the industries under consideration lend support to the survival of the fittest hypothesis. The estimation results also highlight the important effects of industry, domestic and international economic conditions on bankruptcy rates.     

The role of corporate governance in forecasting bankruptcy: Pre- and post-SOX enactment

This paper contributes to the literature by documenting the improved performance of bankruptcy prediction models after including corporate governance variables. The empirical results demonstrate better predictive power for financial bankruptcy than previous bankruptcy prediction models, particularly in the post-SOX period. Our theoretical argument emphasizes the urgent need for such improvements to the bankruptcy prediction model following the introduction of the SOX Act, with the empirical results providing intuitive economic meaning for all relevant market participants. Policymakers may consider enacting laws to include designs for corporate governance monitoring mechanisms, entrepreneurs may use this model to improve their own governance structures and compensation mechanisms to avoid financial bankruptcy, and investors may refer to it to ensure that ‘losers’ are excluded from their investment portfolios.     

On the determinants of foreign ownership shares: Evidence from US firms' joint ventures in Japan

It is often argued that firms' foreign expansion is motivated by economies of scale in information-based intangible assets. Since these assets are combined with local factors in real production, their owner often has to deal with local factor owners' opportunistic behavior such as siphoning of skills which reduces the return on intangibles to the original owner. Local factor owners' agency behavior can also reduce a subsidiary's profit. Maintaining ownership mitigates the former type of opportunistic behavior, while ceding ownership reduces the latter type. Hence there is a non-linear relationship between ownership and the cost of control. In this paper we present a model that incorporates these aspects of a joint venture ownership. In our model the share in a joint venture of a foreign parent firm with a superior technology is determined such that its marginal cost of control is set equal to the marginal benefit it derives from a joint venture. We assume that, because of the uniqueness and mobility of its intangible factor, the foreign partner has more bargaining power than its local counterpart regarding the ownership of their joint venture and that the local partner is less concerned than its foreign counterpart about the problems of agency and property rights protection because of its geographic and cultural proximity to the joint venture. As a consequence, the foreign partner is able to exert its preference for its ownership share in the joint venture. Our theoretical results allow a decomposition of ownership share into components explained by the cost of control and by the profitability of a joint venture. Our empirical results using data on technology-based US firms' subsidiaries in Japan are consistent with our model predictions. In particular, the fraction of ownership share explained by the cost of control relative to the fraction explained by intrinsic profitability is higher for industries that rely more heavily on intangible assets, as expected from the model.     

A journey home: What drives how long people are homeless?

This paper uses survival analysis to model exits from two alternative forms of homelessness: sleeping on the streets (‘literal homelessness’) and not having a home of one's own (‘housing insecurity’). We are unique in being able to account for time-invariant, unobserved heterogeneity. Like previous researchers, we find results consistent with negative duration dependence in models which ignore unobserved heterogeneity. However, controlling for unobserved heterogeneity, we find that duration dependence has an inverted U-shape with exit rates initially increasing (indicating positive duration dependence) and then falling. Exit rates out of both literal homelessness and housing insecurity fall with age. Women are more likely than men to exit housing insecurity for a home of their own, but are less likely to exit literal homelessness. Persons with dependent children have higher exit rates. Finally, education seems to protect people from longer periods of housing insecurity.     

Analyzing the Relationships among Race,Wealth, and Home Ownership in America

This paper presents new evidence on the determinants of the large disparities in home ownership by race in the U.S. Consistent with results first reported by P. Linneman and S. M. Wachter (1989,AREOFA J.7, No. 4, 389–402), we find noceteris paribusracial differences in ownership rates among white and minority households who possess sufficient wealth to meet down payment and closing cost requirements associated with standard mortgage underwriting criteria. However, substantial racial differences among wealth-constrained households exist, with constrained whites owning at higher rates than observationally equivalent minority households. Because minorities are disproportionately constrained by wealth-related underwriting standards, these differentials apply to roughly one-third of the white households in our samples and well over one-half of the minority sample. A multinomial model that treats central city versus suburban location as a choice variable in addition to tenure status is also estimated. The results show that even among households unconstrained by wealth-related underwriting considerations, minorities are much more likely than whites to own in central city locations. Thus, while controlling for wealth constraint status does eliminate tenure choice differences among the unconstrained, location differences remain for this group. They also are present among constrained households. Given the disparate fortunes of central city and suburban land markets in many metropolitan areas, this racial location pattern of ownership may have important long-run impacts on wealth distribution by race.     

Renting vs buying a home: A matter of wealth accumulation or of geographic stability?

I study the housing tenure decision in the context of a spatial life cycle model with uninsurable individual income risk, plausibly calibrated to match key features of the US housing market. I find that the relatively low ownership rate of young households is mainly explained by their high geographic mobility. Downpayment constraints have minor quantitative implications on ownership rates, except for old households. I also find that idiosyncratic earnings uncertainty has a significant impact on homeownership rates. Based on these results, I argue that the long term increase in ownership rates observed over the period 1993–2009 was not necessarily due to mortgage market innovations and the relaxation of downpayment requirements, as is often argued. Instead, it was simply an implication of US demographic evolution, most notably the decline in interstate migration and, less importantly, population ageing. The model predicts that an increase in the income risk (i.e. higher income inequality) has a positive impact on geographical mobility of young households, which means that young homeowners are less affected by the labour market inefficiency associated with homeownership.     

Ownership structure and hospital service costs and fees: A decomposition approach

This paper analyzes hospital characteristics that are associated with higher average costs and charges for venipuncture, computed tomography procedures (computerized axial tomography [CAT] scans), and electrocardiograms (EKG). Using data from a Medicare database, our results indicate that higher wages, larger hospital sizes, and greater service quality are associated with higher procedure costs, whereas system membership is generally associated with lower procedure costs. Blinder‐type decompositions, which are the main focus of this study, suggest (a) that venipuncture costs are about 17% to 19% lower at proprietary hospitals than at nonprofit or government hospitals, (b) CAT scan costs are about 6% to 12% lower at nonprofit hospitals than at proprietary and government hospitals, and (c) that EKG costs are about 3% lower at proprietary hospitals than at nonprofit or government hospitals. Lastly, large portions of each of these differences are found to be due to both differences in mean values of the hospitals' characteristics by ownership type and differences in the mechanism by which the hospitals' characteristics are transmitted to procedure costs.     

Measuring the external benefits of homeownership

The subsidization of homeownership is justified on efficiency grounds only to the extent that it provides benefits to people other than the homeowner. We use the clustered neighborhoods subsample in the American Housing Survey to measure that benefit in the form of higher housing prices in neighborhoods with higher ownership rates (and lower vacancies). We attempt to account for unobservable neighborhood and house attributes that may be correlated with occupancy and ownership through instrumental variables, switching regressions and panel methods. Estimates indicate that a housing transition from renting to owning creates approximately $1300 in measured benefits.