Do Certificate-of-Need Laws Increase Indigent Care?

The Effect of Certificate of Need Laws on All‐Cause Mortality

“…Therefore, my main regressions use data on the scope of CON laws in the years 1992–2011 from Stratmann and Russ (). Their data are derived from reports of the American Health Planning Association, who have monitored state CON laws and tracked whether states have each of 28 types of CON law.…”

“… Objective To test how Certificate of Need laws affect all‐cause mortality in the United States. Data Sources The data of 1992–2011 all‐cause mortality are from the Center for Disease Control's Compressed Mortality File; control variables are from the Current Population Survey, Behavioral Risk Factor Surveillance System, and Area Health Resources File; and data on Certificate of Need laws are from Stratmann and Russ (). Study design Using fixed‐ and random‐effects regressions, I test how the scope of state Certificate of Need laws affects all‐cause mortality within US counties. Principal Findings Certificate of Need laws have no statistically significant effect on all‐cause mortality. Point estimates indicate that if they have any effect, they are more likely to increase mortality than decrease it. Conclusions Proponents of Certificate of Need laws have claimed that they reduce mortality by concentrating more care into fewer, larger facilities that engage in learning‐by‐doing.…”

“…The data of 1992–2011 all‐cause mortality are from the Center for Disease Control's Compressed Mortality File; control variables are from the Current Population Survey, Behavioral Risk Factor Surveillance System, and Area Health Resources File; and data on Certificate of Need laws are from Stratmann and Russ ().…”

The Economics of a Bed Shortage: Certificate-of-Need Regulation and Hospital Bed Utilization during the COVID-19 Pandemic

“…Previous studies have found that CON regulations are associated with fewer beds per capita (Joskow 1980;Harrington et al 1997;Hellinger 2009;Eichmann and Santerre 2011;Stratmann and Russ 2014). In the spring of 2020 we examined the link between bed CONs and projected shortages during the pandemic with James Bailey (Mitchell et al 2020).…”

“…Here, the evidence is overwhelming: CON laws restrict access to care, especially for certain populations such as rural communities and ethnic minorities. Researchers find that compared with the experience of patients in non-CON states, the average patient in a CON state has access to fewer hospitals (Stratmann and Russ 2014), fewer ambulatory surgery centers (ASCs) (Stratmann and Koopman 2016;Stratmann and Baker 2020), fewer rural hospitals and rural ASCs (Stratmann and Koopman 2016), fewer hospice care facilities (Carlson et al 2010), fewer dialysis clinics (Ford and Kaserman 1993), and fewer hospitals offering certain procedures (Robinson et al 2001;Popescu et al 2006;Ho et al 2007;Short et al 2008;Kolstad 2009;Ho et al 2009;Vaughan Sarrazin et al 2010). Patients in CON states wait longer for care (Myers and Sheehan 2020), tend to travel longer distance to obtain care (Kolstad 2009;Cutler et al 2010;Carlson et al 2010), and are more likely to leave their states for care (Baker and Stratmann 2021).…”