The price of placements in residential and nursing home care: The effects of contracts and competition

A variety of contract types are used in the placement of elderly people in residential and nursing care homes in the UK. Contracts vary according to how and when providers are paid. Among other things, prices can be made contingent on the total quantity of service to be purchased and on production cost characteristics. They can be determined at the time of placement or in advance. The primary objective of this paper is to assess the impact of contract choices on the price of placements. Regression analysis was conducted on a final sample of 1780 publicly funded placements made in 18 local authorities in the UK over a 6-month period ending in early 1996. Controlling factors included in the price analysis were production cost indicators and those measuring market competitiveness. Choices of both quantity and cost contingent contracts were found to be significantly associated with placement prices. The findings support the hypothesis that contract payment arrangements have different risk, insurance and information properties, and so have implications for the performance of residential care providers.