The Effects of Regulation on Quality: Evidence from the Nursing Home Industry

Meghan McMahon is Program Director with the Canadian Institutes of Health Research’s Institute of Health Services and Policy Research. She is completing her PhD in the Institute of Health Policy, Management and Evaluation at the University of Toronto and is a Fellow with the Canadian Centre for Health Economics. Meghan’s dissertation examines the effect of regulation on quality in the long-term care setting, and whether effects vary across different types of long-term care facilities. Meghan previously worked at the UBC Centre for Health Services and Policy Research and completed an internship with the Organization for Economic Cooperation and Development, both in the area of pharmaceutical policy. Meghan has a MSc in Health Services Research from the University of Toronto.

Abstract

This presentation will provide a systematic review of the peer-reviewed literature of the effects (intended and unintended) of regulation on quality of care in long-term care (LTC) facilities. We identified three primary types of regulation – direct quality regulation, nurse staffing regulations, and payment regulations – and within these broad categories we identified 11 distinct types of regulatory interventions. Overall, the majority of the studies found that regulation improved quality in the dimension explicitly targeted by the regulation. However, of the 80 studies that examined multiple measures of quality, none observed improvements in all areas. Rather, most studies found that quality improved in some dimensions and declined or was unaffected in others. Unintended effects – such as worse quality in non-regulated areas, facility closure, and decline in staffing skill mix – were not uncommon.