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Forum for Health Economics & Policy

Editor-in-Chief: Goldman, Dana / Romley, John

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Competitive Spillovers and Regulatory Exploitation by Skilled Nursing Facilities

John R. Bowblis / Christopher S. Brunt
  • Department of Finance & Economics, Georgia Southern University, PO Box 8152, Statesboro, GA 30460, USA
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/ David C. Grabowski
  • Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, USA
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Published Online: 2015-05-01 | DOI: https://doi.org/10.1515/fhep-2014-0006


Typically, research on the effect of ownership has considered health care providers in isolation of competitive interaction from other firms. This analysis considers how the selection of Medicare reimbursement codes for skilled nursing facilities varies by ownership and is influenced by the competitive spillovers from market dominance of for-profit institutions. We find evidence that not-for-profits are less likely to code patients into the highest reimbursement categories. Further, as the market becomes dominated by for-profits, both for-profit and not-for-profits increase the share of patients in these high reimbursement categories.

Keywords: Medicare; not-for-profit; post-acute care; skilled nursing facilities; upcoding


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About the article

Corresponding author: John R. Bowblis, Department of Economics, Miami University, 800. E. High Street, Oxford, OH 45056, USA, e-mail: jbowblis@miamiOH.edu

Published Online: 2015-05-01

Published in Print: 2016-06-01

Citation Information: Forum for Health Economics and Policy, Volume 19, Issue 1, Pages 45–70, ISSN (Online) 1558-9544, ISSN (Print) 2194-6191, DOI: https://doi.org/10.1515/fhep-2014-0006.

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