Nonprofit vs. for Profit: Allocation of Beds and Access to Care in US Nursing Homes

• 成果类型: Article; Early Access
• 署名作者: Jiang, Yangzi; Lu, Lauren Xiaoyuan; Van Mieghem, Jan Albert
• 署名单位: The Chinese University of Hong Kong, Shenzhen; Dartmouth College; Northwestern University
• 刊物名称: M&SOM-MANUFACTURING & SERVICE OPERATIONS MANAGEMENT
• ISSN/ISSBN: 1523-4614
• DOI: 10.1287/msom.2024.0937
• 发表日期: 2026
• 关键词: multiserver queues

摘要

Problem definition: U.S. nursing homes allocate federal licensed beds among three categories: Medicare-dedicated beds, Medicaid-dedicated beds, and flexible beds for both populations. This article studies how nonprofit and for-profit nursing homes make bed allocation decisions and how this affects access to care for the economically disadvan-taged Medicaid population. Methodology/results: Analyzing U.S. nursing home data dur-ing 2012-2017, we observe that nonprofit nursing homes on average had a higher Medicare-dedicated bed share than for-profit ones. Furthermore, nursing homes reduced their Medicare-dedicated bed share after being converted from nonprofit to for profit. Motivated by these empirical observations, we construct a queueing network model to study the bed allocation decision of a nursing home, whose objective function is formu-lated as the sum of its profit and its resident welfare, including the costs of blocking and waiting, weighted by the degree of altruism. The higher the altruism is, the more a nursing home acts like a nonprofit organization that cares about not only profit but also, resident welfare. We show that when prospective Medicaid demand is sufficiently high, more altru-istic nursing homes choose a higher Medicare-dedicated bed share, thereby lowering Med-icaid access; when prospective Medicare demand is sufficiently low, they choose a lower Medicare-dedicated bed share, thereby increasing Medicaid access. We further calibrate the model to predict the directional change in bed allocation following ownership conver-sions. Managerial implications: Contrary to common concerns, our empirical analysis shows that the expansion of the for-profit nursing home sector does not necessarily reduce access to care for the Medicaid population. Our theoretical model demonstrates that the impact of ownership type on bed allocation is shaped by the local demand mix from pro-spective Medicare and Medicaid residents. These findings offer actionable guidance for regulators evaluating ownership conversion requests, with our data-calibrated framework helping to inform approval decisions.