Background Paper: Rural and Urban Differences in Nursing Home and Skilled Nursing Supply. Working Paper Series No. 74.

摘要

The objective of this working paper is to examine characteristics of nursing facilities and the supply of certified skilled nursing beds as the new PPS is being phased in, with particular reference to differences between urban and rural settings. The paper is intended as a background piece for a follow-up study of the impact of PPS on the delivery of skilled nursing services in rural areas, to be conducted after cost and utilization data become available for the years during and after the PPS phase-in. The first section of this paper describes the nursing home industry and skilled nursing facilities as a component of that industry. The second section provides a detailed examination of urban-rural differences in institutional characteristics. Using urban influence codes as defined by the U.S. Department of Agriculture, we compute separate statistics for facilities located in metropolitan counties, and then aggregate the data from facilities in non-metropolitan counties by town size and by county adjacency to metropolitan areas. The principal data source for our urban-rural analyses is the Online Survey, Certification and Reporting System file (OSCAR), produced and updated quarterly by the Centers for Medicare and Medicaid Services (CMS, formerly Health Care Financing Administration, or HCFA). The file used for this paper was received in March of 2001. The licensure data are supplemented by utilization data from Medicare skilled nursing facility cost reports from the federal fiscal year 1998 (the last period prior to PPS implementation). Institution-level data have been merged with county-level population figures from the 2000 census.