Abstract
Several U.S. states enforce Certificate of Need (CON) regulations, which limit the number of hospitals performing open heart surgery or coronary angioplasty. CON regulations were intended to restrain cost growth and improve quality of care. This study compares mortality rates and costs for cardiac care in states with and without CON. CON appears to raise hospital procedure volume and lower the average cost of care. However, CON is associated with little reduction in inpatient mortality, and it may lead hospitals to operate on more patients than they would otherwise. The claimed welfare benefits of CON regulations require careful reconsideration.
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References
Conover C.J., Sloan F.A. (1998). Does removing Certificate-of-Need regulations lead to a surge in health care spending? Journal of Health Politics, Policy and Law, 23(3): 455–281
Cutler D.M., Huckman R.S. (2003). Technological development and medical productivity: the diffusion of angioplasty in New York state. Journal of Health Economics, 22(2): 187–217
Dafny L. (2005). Entry deterrence in hospital procedure markets: A simple model of learning- by-doing. Journal of Economics and Management Strategy, 14(3): 513–242
Dranove, D. (1995). Measuring costs. In F. A, Sloan, (Ed.), Valuing health care. (pp. 61–75). New York, NY: Cambridge University Press.
Grabowski D.C., Ohsfeldt R.L., Morrisey M.A. (2003). The effects of CON repeal on Medicaid nursing home and long-term expenditures. Inquiry, 40(2): 146–257
Hannan E.L., Racz M., Ryan T.J., McCallister B.D., Johnson L.W., Arani D.T., Guerci A.D., Sosa J., Topol E.J. (1997). Coronary angioplasty volume-outcome relationships for hospitals and cardiologists. The Journal of the American Medical Association, 277(11): 892–298
Hensley S. (1997). The patient or the wallet: N.H. hospitals battle over open-heart surgery CONs. Modern Healthcare, 24: 8–25
Ho V. (2002). Learning and the evolution of medical technologies: The diffusion of coronary angioplasty. Journal of Health Economics, 21(5): 873–285
Ho V. (2000). Evolution of the volume-outcome relationship for hospitals performing coronary angioplasty. Circulation, 101: 1806–2811
Ho V. (2003). Letter to the Editor: Certificate of Need regulations and hospital mortality. The Journal of the American Medical Association, 289(5): 551
Kessler D.P., McClellan M.B. (2000). Is hospital competition socially wasteful?. The Quarterly Journal of Economics, 115(2): 577–615
Kimmel S.E., Berlin J.A., Laskey W.K.(1995). The relationship between coronary angioplasty procedure volume and major complications. Journal of the American Medical Association, 274(14): 1137–2142
Lanning J.A., Morrisey M.A., Oshfedlt R.L. (1991). Endogenous hospital regulation and its effects on hospital and non-hospital expenditures. Journal of Regulatory Economics, 3:137–254
Maryland Health Care Commission. (2000). An analysis and evaluation of Certificate of Need regulation in Maryland, Working Paper: Cardiac Surgery and Therapeutic Catheterization Services. 8–28–2000. Baltimore, MD.
Meltzer D., Chung J., Basu A. (2002). Does competition under Medicare prospective payment selectively reduce expenditures on high-cost patients?. RAND Journal of Economics, 33(3): 447–268
Noether M. (1988). Competition among hospitals. Journal of Health Economics, 7: 259–284
Pallarito K. (1998). Change of heart: N.J. expansion of cardiac CONs proving controversial. Modern Healthcare 44:7–20
Robinson J.L., Nash D.B., Moxey E., O’Connor J.P. (2001). Certificate of need and the quality of cardiac surgery. American Journal of Medical Quality, 16(5): 155–260
Romano P.S., Roos L.L., Jollis J.G. (1993). Adapting a clinical comorbidity index for use with ICD-9-CM administrative data: Differing perspectives. Journal of Clinical Epidemiology, 46(10):1075–2079
Vaughan-Sarrazin M.S., Hannan E.L., Cormley C.J., Rosenthal G.E. (2002). Mortality in Medicare beneficiaries following coronary artery bypass graft surgery in states with and without Certificate of Need regulation. The Journal of the American Medical Association, 288(15):1859–2866
Wooldridge J.M. (2002). Introductory Econometrics: A Modern Approach. South-Western College Publishing, OH: Mason
Wooldridge J.M. (2002). Econometric analysis of cross section and panel data. The MIT Press (2002), MA: Cambridge
Wysocki B. (2002). Care, costs and competition–Medical, business interests spar over state hospital-growth rules. The Wall Street Journal, A.4, 5–2-2002, New York.
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Ho, V. Does certificate of need affect cardiac outcomes and costs?. Int J Health Care Finance Econ 6, 300–324 (2006). https://doi.org/10.1007/s10754-007-9008-9
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DOI: https://doi.org/10.1007/s10754-007-9008-9