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Minimum Nurse Staffing Legislation and the Financial Performance of C alifornia Hospitals
Author(s) -
Reiter Kristin L.,
Harless David W.,
Pink George H.,
Mark Barbara A.
Publication year - 2012
Publication title -
health services research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.706
H-Index - 121
eISSN - 1475-6773
pISSN - 0017-9124
DOI - 10.1111/j.1475-6773.2011.01356.x
Subject(s) - staffing , quartile , medicine , legislation , nursing , business , confidence interval , political science , law
Objective To estimate the effect of minimum nurse staffing ratios on C alifornia acute care hospitals’ financial performance. Data Sources/Study Setting Secondary data from M edicare cost reports, the A merican H ospital A ssociation's ( AHA ) A nnual S urvey, and the C alifornia O ffice of S tatewide H ealth P lanning and D evelopment ( OSHPD ) are combined from 2000 to 2006 for 203 hospitals in C alifornia and 407 hospitals in 12 comparison states. Study Design The study employs a difference‐in‐difference analytical approach. Hospitals are grouped into quartiles based on pre‐regulation nurse staffing levels in adult medical‐surgical and pediatric units (quartile 1 = lowest staffing). Differences in operating margin, operating expenses per day, and inpatient operating expenses per discharge for C alifornia hospitals within a staffing quartile during the period of regulation are compared to differences at hospitals in comparison states during the same period. Data Collection/Extraction Methods Hospital data from M edicare cost reports are merged with nurse staffing measures obtained from AHA and from OSPHD . Principal Findings Relative to hospitals in comparison states, operating margins declined significantly for C alifornia hospitals in quartiles 2 and 3. Operating expenses increased significantly in quartiles 1, 2, and 3. Conclusions Implementation of minimum nurse staffing legislation in C alifornia put substantial financial pressure on some hospitals.