ADAPTIVE RESPONSE TO REGULATION: THE CASE OF NURSING HOMES.
Contributors: Virginia Commonwealth University.
Published: 1991
Number of pages: 125
Subjects: Health Sciences, Public Health.
Description: This study examined the effect of state regulatory control factors on the organizational response of nursing homes. The framework of the study derives from the theory of organizational response to regulation proposed by Cook et al. (1983).

The primary purpose was to determine whether nursing homes respond differently in terms of the number and type of services provided and the number purchased from outside providers when regulatory control, measured by eligibility, certificate-of-need and reimbursement factors, becomes more restrictive.

State and county level data were merged with the 1985 Provider of Services File. The data set consisted of 14,299 observations. The unit of analysis was the nursing home.

Data were analyzed using correlation analysis, analysis of variance and path analysis. A positive association was shown between eligibility and reimbursement control (.51). Facility location was positively associated with number of acute beds (r =.84) and negatively associated aged population (r = $-$.61).

Analysis of variance confirmed that mean differences across states for the organizational response and the regulatory control variables were not all equal.

Path analysis was performed to determine what effect regulatory control exerted on organizational response. Not all hypotheses were supported by the analysis and effects were weak in most cases. In support of the hypothesis, eligibility was shown to exert a positive direct effect (0.21) on the number of clinical services provided. Certificate-of-need exerted a weak but positive indirect effect on the purchase of skilled services. Opposite to the hypothesized direction, reimbursement exerted the most influence on rehabilitation services, with a positive direct effect (0.10). Goodness-of-fit tests indicated that any differences between the predicted model and observed data could be attributed to sampling fluctuations.

Results of the study indicate a need to focus attention on variable selection and measurement and on the dynamics of organizational and environmental relationships in the nursing home industry.

This study of nursing home response to regulation has contributed to an understanding of the effect of environmental pressure on organizational adaptation.
Notes: Source: Dissertation Abstracts International, Volume: 52-07, Section: B, page: 3559.

Thesis (PH.D.)--VIRGINIA COMMONWEALTH UNIVERSITY, 1991.

School code: 2383.