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Comparison of nursing home financial transparency and accountability in four locations
- Authors:
- HARRINGTON Charlene, et al
- Journal article citation:
- Ageing International, 41(1), 2016, pp.17-39.
- Publisher:
- Springer
- Place of publication:
- New York
The marketisation and privatisation of nursing home care has grown in many countries along with expenditures. Using documents and government reports, this study explored three research questions about nursing homes in California, Ontario, England, and Norway. What were: (1) the contextual and privatisation differences; (2) payment methods and trends in revenues and expenditures for direct care, administration, and profits; and (3) the financial reporting and accountability systems? The findings showed nursing homes were highly privatised in all locations except Norway. Revenues and expenditures increased steadily in all locations. Direct care services were lower in California and England where privatisation was highest. Administrative costs were high especially in for-profit companies, except in Norway’s municipal nursing homes. Profit margins were generally not reported or under reported, but high margins were found in for-profits and chains where reports were available. Contrary to the hypothesis that financial transparency and accountability would increase with privatisation, only California and the U.S. had developed detailed public financial reporting, although these reports could be improved. Ontario required detailed financial reporting except for administration and profits and the information was not publicly available. England and Norway had no public systems for financial reporting. None of the locations had cost controls on administration and profits, except for Medicaid administration controls in California. Policy makers need to focus on improvements in financial transparency and accountability to assure value for expenditures and to potentially improve quality. (Edited publisher abstract)
Mapping nursing home inspections & audits in six countries
- Authors:
- CHOINIERE Jacqueline A., et al
- Journal article citation:
- Ageing International, 41(1), 2016, pp.40-61.
- Publisher:
- Springer
- Place of publication:
- New York
International quality concerns regarding long-term residential care, home to many of the most vulnerable among us, prompted the authors to examine the audit and inspection processes in six different countries. Drawing on Donabedian’s (Evaluation & Health Professions, 6(3), 363–375, 1983) categorisation of quality criteria into structural, process and outcome indicators, this paper compares how quality is understood and regulated in six countries occupying different categories according to Esping Andersen’s (1990) typology: Canada, England, and the United States (liberal welfare regimes); Germany (conservative welfare regime); Norway, and Sweden (social democratic welfare regimes). In general, our review finds that countries with higher rates of privatisation (mostly the liberal welfare regimes) have more standardised, complex and deterrence-based regulatory approaches. The authors identify that even countries with the lowest rates of for profit ownership and more compliance-based regulatory approaches (Norway and Sweden) are witnessing an increased involvement of for-profit agencies in managing care in this sector. The authors' analysis suggests there is widespread concern about the incursion of market forces and logic into this sector, and about the persistent failure to regulate structural quality indicators, which in turn have important implications for process and outcome quality indicators. (Edited publisher abstract)