Implications of global budget payment system on nursing home costs. The case of Switzerland

Pressure on health care systems due to the increasing expenditures of the elderly population is pushing policy makers to adopt new regulation and payment schemes for nursing home services. We sketch a simple theoretical model to predict the behavior of nursing homes under different payment schemes. We then investigate the implications of prospective payments on nursing home costs using a panel of 41 homes in Southern Switzerland observed over a 12-years period (1999-2010). To evaluate the impact of the recent policy change - from retrospective to prospective payment - we employ a fixed effects model with a time trend that is allowed to change after the policy reform. We Önd evidence that the new payment system reduces costs for nursing home care, ceteris paribus. This result is in line with the theoretical expectations.