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The impact of certificate of need laws on heart attack mortality: Evidence from county borders

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  • Chiu, Kevin

Abstract

Certificate of need (CON) regulations requires that health care providers obtain state approval before offering a new service or expanding existing facilities. The purported goal of CON regulations is to reduce health care costs by generating regional economies of scale and reducing redundant investments resulting from excessive competition. Critics of CON regulations note that the regulatory environment increases the costs of expansion and may incentivize health care providers to forgo capital investment, which can have a negative effect on health outcomes. To estimate the net effect of CON regulations, I use a border discontinuity design to measure within-regional heart attack mortality spanning 1968 to 1982. I estimate that CON regulations led to an increase in heart attack deaths, by 6%-10%, three years after the policy was enacted.

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  • Chiu, Kevin, 2021. "The impact of certificate of need laws on heart attack mortality: Evidence from county borders," Journal of Health Economics, Elsevier, vol. 79(C).
    • Handle: RePEc:eee:jhecon:v:79:y:2021:i:c:s016762962100103x
    DOI: 10.1016/j.jhealeco.2021.102518
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    Cited by:

    1. Jill Horwitz & Austin Nichols & Carrie H. Colla & David M. Cutler, 2024. "Technology Regulation Reconsidered: The Effects of Certificate of Need Policies on the Quantity and Quality of Diagnostic Imaging," NBER Working Papers 32143, National Bureau of Economic Research, Inc.
    2. Thomas Stratmann & Markus Bjoerkheim & Christopher Koopman, 2024. "The Causal Effect of Repealing Certificate-of-Need Laws for Ambulatory Surgical Centers: Does Access to Medical Services Increase?," Papers 2405.08160, arXiv.org.
    3. Shishir Shakya & Christine Bretschneider Fries, 2023. "Impacts of Certificate-of-need State Laws on Substance Abuse Treatment Facilities and Services," Working Papers 23-08, Department of Economics, Appalachian State University.
    4. Matthew Mitchell & Thomas Stratmann, 2021. "The Economics of a Bed Shortage: Certificate-of-Need Regulation and Hospital Bed Utilization during the COVID-19 Pandemic," JRFM, MDPI, vol. 15(1), pages 1-18, December.
    5. Thomas Stratmann, 2022. "The Effects of Certificate-of-Need Laws on the Quality of Hospital Medical Services," JRFM, MDPI, vol. 15(6), pages 1-29, June.
    6. Vitor Melo & Liam Sigaud & Elijah Neilson & Markus Bjoerkheim, 2024. "Rural Healthcare Access and Supply Constraints: A Causal Analysis," Papers 2405.08168, arXiv.org.

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    More about this item

    Keywords

    Certificate of need; CON; Acute myocardial infarction; Mortality; Heart attack; Health policy; Border discontinuity;
    All these keywords.

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • H75 - Public Economics - - State and Local Government; Intergovernmental Relations - - - State and Local Government: Health, Education, and Welfare
    • R58 - Urban, Rural, Regional, Real Estate, and Transportation Economics - - Regional Government Analysis - - - Regional Development Planning and Policy

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