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. 2020 Aug 14;20(1):748.
doi: 10.1186/s12913-020-05563-1.

Certificate of need laws: a systematic review and cost-effectiveness analysis

Christopher J Conover  1 , James Bailey  2
Affiliations

Certificate of need laws: a systematic review and cost-effectiveness analysis

Christopher J Conover et al. BMC Health Serv Res. .

Abstract

Background: Certificate of Need (CON) laws, currently in place in 35 US states, require certain health care providers to obtain a certification of their economic necessity from a state board before opening or undertaking a major expansion. We conduct the first systematic review and cost-effectiveness analysis of these laws.

Methods: We review 90 articles to summarize the evidence on how certificate of need laws affect regulatory costs, health expenditures, health outcomes, and access to care. We use the findings from the systematic review to conduct a cost-effectiveness analysis of CON.

Results: The literature provides mixed results, on average finding that CON increases health expenditures and overall elderly mortality while reducing heart surgery mortality. Our cost-effectiveness analysis estimates that the costs of CON laws somewhat exceed their benefits, although our estimates are quite uncertain.

Conclusions: The literature has not yet reached a definitive conclusion on how CON laws affect health expenditures, outcomes, or access to care. While more and higher quality research is needed to reach confident conclusions, our cost-effectiveness analysis based on the existing literature shows that the expected costs of CON exceed its benefits.

Keywords: Certificate of need; Cost-effectiveness analysis; Hospital regulation; Systematic review.

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Conflict of interest statement

The authors have no competing interests to declare.

Figures

Fig. 1
Fig. 1
Net Costs of Certificate of need, 2008
See this image and copyright information in PMC

References

    1. Viscusi WK. Pricing lives: guideposts for a safer society. Princeton: Princeton University Press; 2018.
    1. Conover CJ, Sloan FA. Evaluation of certificate of need in Michigan. Volume II: technical appendices. Raleigh, NC: Duke University Center for Health Policy, Law and Management; 2003.
    1. Simpson JB. Full circle: the return of certificate of need regulation of health facilities to state control. Indiana Law Review. 1986;19:1025–1127.
    1. American Health Planning Association . National directory: 2012. Fairfax, VA: AHPA; 2014.
    1. American Health Planning Association . Certificate of need coverage summary, by state, 2008. Fairfax, VA: AHPA; 2009.

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