Tradeoffs Are Omnipresent, Even With Covid
My findings show that for-profit nursing homes had less restrictive isolation measures during the pandemic than did not-for-profit nursing homes and that the increase in non-COVID deaths caused by more restrictive isolation measures outweighed the decrease in COVID-19 deaths associated with these measures. Thus, I find that for-profit nursing homes had fewer total deaths than not-for-profit nursing homes during the pandemic. Furthermore, decisions over isolation measures were affected by factors unrelated to the health of residents, such as incentives associated with different ownership structures.
This is from Victor Melo, “Understanding Nonprofit and Government Ownership: Evidence from Nursing Homes in the Covid-19 Pandemic,” Mercatus Center, January 25, 2023.
From the start, many of us who were skeptical of, or even opponents of, government lockdowns pointed out that advocates of lockdowns often ignored tradeoffs.
This paper doesn’t address lockdowns per se, but does point out the tradeoffs. Deaths from non-Covid causes matter too.
Interestingly, Melo doesn’t look at the effects of Governors Cuomo (New York), Wolf (Pennsylvania), Whitmer (Michigan), and Murphy (New Jersey) requiring nursing homes to accept people carrying Covid. It’s possible that he didn’t have the data to do so.
Jan 30 2023 at 10:33pm
Not an especially strong study. Based upon some earlier literature the author claims that people are more likely to die from dementia and other non covid causes from a lack of visitors/loneliness. However, at least one of the sources listed as evidence is a newspaper article and not any kind of causative study. I stopped reading the other sources when I came to that one since that’s a bad sign in literature making strongly assertive claims ie SNR likely to be poor. Then the author shows that non profits had a higher death rate, but does not show that the higher death rate is due to the kinds problems that might be due to isolation, rather he just assumes that the extra deaths must be due to lack of visits.
Of note, the nursing homes owned and run by govt institutions had fewer deaths than both for-profits and non-profits.
Jan 31 2023 at 9:44am
Thanks for your comment.
One question. You wrote:
Covid deaths or total deaths? If the former, that doesn’t contradict this author’s findings.
Jan 31 2023 at 10:16am
The govt runs were lower in total deaths and non-covid deaths than both for- and non- profits. They were lower in covid deaths than for profits but higher for non-profits. Of note, there are fewer govt runs so dont know the absolute numbers. I would think they would still be large enough to be meaningful but dont know for sure. One of my staff is married to a geriatric specialist who runs a couple of nursing homes so I could probably find out.
Jan 31 2023 at 7:44am
Good piece. I’m going to share it with my Health Economics class this semester.
One of the hardest things break in people is the whole “save a life at any cost” mindset. Both to show them that it isn’t true (we constantly put implicit values on our lives, and often very low. Eg texting while driving) and that it’s impossible.
Jan 31 2023 at 10:30am
Interesting, as I was thinking of adding to my list of poorly done studies to show our medical students. There is at best a retrospective association and there is no causal link. He goes to the trouble of comparing 3 groups, for-profit, non-profit and government, then omits the govt one in his analysis. That would be valid if this were a study with controls and some kinds of interventions and the study was designed to look at only those two groups and that was an incidental finding. However, this was just a retrospective review of statistics. Also, maybe I missed it since i did read this late at night, but the paper doesnt acknowledge that there is a body of literature suggesting that at baseline there are differences in care at non-profits and for-profits. So, for me and think most of us in medicine this is the kind of paper where we say this is kind of interesting but doesnt mean much and someone needs to do a real study if we want a real answer.
I was also shocked to find that the Aronson source he cited turned out to be a newspaper article. Having reviewed, formally and informally, quite a few papers to be published in medical journals that was surprising to me, but maybe its normal for economics journals.
Jan 31 2023 at 10:55am
Oh? When I was working on my dissertation, I was deep into the med lit on covid. I saw newspapers cited all the time. Personally, I see no reason not to cite newspapers if they provide useful information. If the info is false, that’s a whole other story of course.
One thing to also keep in mind is all this information is still fresh. One should not expect to find many academic studies as the data collection process is still underway. You go with what you can get.
Jan 31 2023 at 2:44pm
Newspapers dont get cited in top level journals as a rule, or they may get cited if an article is notable because it rolls in lots of citations on a given topic. However, the Aronson piece was largely a data free piece talking about how horrible it was to die alone in a nursing, an appeal to emotion.
This may be fresh but it has too many red flags for me. Its not useful in terms of making any actual recommendations. I guess if you presented it in the form of this article has some interesting suggestions that should make you think but it doesnt actually prove or show anything in any casual form then maybe it might be OK. I would hope you could find better examples for that.
Comments are closed.