IDEAS home Printed from https://ideas.repec.org/p/arx/papers/2405.08168.html
   My bibliography  Save this paper

Rural Healthcare Access and Supply Constraints: A Causal Analysis

Author

Listed:
  • Vitor Melo
  • Liam Sigaud
  • Elijah Neilson
  • Markus Bjoerkheim

Abstract

Certificate-of-need (CON) laws require that healthcare providers receive approval from a state board before offering additional services in a given community. Proponents of CON laws claim that these laws are needed to prevent the oversupply of healthcare services in urban areas and to increase access in rural areas, which are predominantly underserved. Yet, the policy could lower rural access if used by incumbents to limit entry from competitors. We explore the repeal of these regulations in five U.S. states to offer the first estimate of the causal effects of CON laws on rural and urban healthcare access. We find that repealing CON laws causes a substantial increase in hospitals in both rural and urban areas. We also find that the repeal leads to fewer beds and smaller hospitals on average, suggesting an increase in entry and competition in both rural and urban areas.

Suggested Citation

  • Vitor Melo & Liam Sigaud & Elijah Neilson & Markus Bjoerkheim, 2024. "Rural Healthcare Access and Supply Constraints: A Causal Analysis," Papers 2405.08168, arXiv.org.
    • Handle: RePEc:arx:papers:2405.08168
    as

    Download full text from publisher

    File URL: http://arxiv.org/pdf/2405.08168
    File Function: Latest version
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. 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.
    2. David M. Cutler & Robert S. Huckman & Jonathan T. Kolstad, 2010. "Input Constraints and the Efficiency of Entry: Lessons from Cardiac Surgery," American Economic Journal: Economic Policy, American Economic Association, vol. 2(1), pages 51-76, February.
    3. Clément de Chaisemartin & Xavier D'Haultfœuille, 2020. "Two-Way Fixed Effects Estimators with Heterogeneous Treatment Effects," American Economic Review, American Economic Association, vol. 110(9), pages 2964-2996, September.
    4. Simpson, J.B., 1985. "State certificate-of-need programs: The current status," American Journal of Public Health, American Public Health Association, vol. 75(10), pages 1225-1229.
    5. Imai, Kosuke & Kim, In Song, 2021. "On the Use of Two-Way Fixed Effects Regression Models for Causal Inference with Panel Data," Political Analysis, Cambridge University Press, vol. 29(3), pages 405-415, July.
    6. Agnitra Roy Choudhury & Sriparna Ghosh & Alicia Plemmons, 2022. "Certificate of Need Laws and Health Care Use during the COVID-19 Pandemic," JRFM, MDPI, vol. 15(2), pages 1-11, February.
    7. Sant’Anna, Pedro H.C. & Zhao, Jun, 2020. "Doubly robust difference-in-differences estimators," Journal of Econometrics, Elsevier, vol. 219(1), pages 101-122.
    8. Nyman, John A, 1994. "The Effects of Market Concentration and Excess Demand on the Price of Nursing Home Care," Journal of Industrial Economics, Wiley Blackwell, vol. 42(2), pages 193-204, June.
    9. Noether, Monica, 1988. "Competition among hospitals," Journal of Health Economics, Elsevier, vol. 7(3), pages 259-284, September.
    10. David M. Cutler & Robert S. Huckman & Jonathan T. Kolstad, 2009. "Input Constraints and the Efficiency of Entry: Lessons from Cardiac Surgery," NBER Working Papers 15214, National Bureau of Economic Research, Inc.
    11. 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).
    12. Vivian Ho, 2006. "Does certificate of need affect cardiac outcomes and costs?," International Journal of Health Economics and Management, Springer, vol. 6(4), pages 300-324, December.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Bailey, James, 2016. "Can Health Spending Be Reined In through Supply Constraints? An Evaluation of Certificate-of-Need Laws," Working Papers 05192, George Mason University, Mercatus Center.
    2. 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).
    3. Suhui Li & Avi Dor, 2013. "How Do Hospitals Respond to Market Entry? Evidence from A Deregulated Market for Cardiac Revascularization," NBER Working Papers 18926, National Bureau of Economic Research, Inc.
    4. James Bailey, 2018. "Does “Excess Supply” Drive Excessive Health Spending? The Case of Certificate-of-Need Laws," Journal of Private Enterprise, The Association of Private Enterprise Education, vol. 33(Winter 20), pages 91-109.
    5. 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.
    6. Roth, Jonathan & Sant’Anna, Pedro H.C. & Bilinski, Alyssa & Poe, John, 2023. "What’s trending in difference-in-differences? A synthesis of the recent econometrics literature," Journal of Econometrics, Elsevier, vol. 235(2), pages 2218-2244.
    7. Goodman-Bacon, Andrew, 2021. "Difference-in-differences with variation in treatment timing," Journal of Econometrics, Elsevier, vol. 225(2), pages 254-277.
    8. Averett, Susan L. & Terrizzi, Sabrina & Wang, Yang, 2017. "Taking the CON out of Pennsylvania: Did Hip and Knee Replacement Patients Benefit?," IZA Discussion Papers 10917, Institute of Labor Economics (IZA).
    9. Garcia, Alberto & Heilmayr, Robert, 2024. "Impact evaluation with nonrepeatable outcomes: The case of forest conservation," Journal of Environmental Economics and Management, Elsevier, vol. 125(C).
    10. Baker, Andrew C. & Larcker, David F. & Wang, Charles C.Y., 2022. "How much should we trust staggered difference-in-differences estimates?," Journal of Financial Economics, Elsevier, vol. 144(2), pages 370-395.
    11. Lamar Pierce & Jason Snyder, 2015. "Unethical Demand and Employee Turnover," Journal of Business Ethics, Springer, vol. 131(4), pages 853-869, November.
    12. Xin Nie & Jianxian Wu & Han Wang & Weijuan Li & Chengdao Huang & Lihua Li, 2022. "Contributing to carbon peak: Estimating the causal impact of eco‐industrial parks on low‐carbon development in China," Journal of Industrial Ecology, Yale University, vol. 26(4), pages 1578-1593, August.
    13. Mortha, Aline & Yajima, Naonari & Arimura, Toshi H., 2024. "Impact of the feed-in-tariff exemption on energy consumption in Japanese industrial plants," Japan and the World Economy, Elsevier, vol. 69(C).
    14. Mohammad Reza Farzanegan & Hassan F. Gholipour & Mostafa Javadian, 2023. "Air pollution and internal migration: evidence from an Iranian household survey," Empirical Economics, Springer, vol. 64(1), pages 223-247, January.
    15. Robert Reinhardt, 2024. "Shaking up Foreign Finance: FDI in a Post-Disaster World," Economics of Disasters and Climate Change, Springer, vol. 8(2), pages 317-348, July.
    16. Davide Cipullo, 2023. "When Women Take All: Direct Election and Female Leadership," CESifo Working Paper Series 10229, CESifo.
    17. Justin T. Callais & Jamie Bologna Pavlik, 2023. "Does economic freedom lighten the blow? Evidence from the great recession in the United States," Economics of Governance, Springer, vol. 24(3), pages 357-398, September.
    18. Richards-Shubik, Seth & Roberts, Mark S. & Donohue, Julie M., 2022. "Measuring quality effects in equilibrium," Journal of Health Economics, Elsevier, vol. 83(C).
    19. Rottner, Elisa, 2023. "Do climate policies lead to outsourcing? Evidence from firm-level imports," ZEW Discussion Papers 23-070, ZEW - Leibniz Centre for European Economic Research.
    20. Simone Balestra & Helge Liebert & Nicole Maestas & Tisamarie B. Sherry, 2021. "Behavioral Responses to Supply-Side Drug Policy During the Opioid Epidemic," NBER Working Papers 29596, National Bureau of Economic Research, Inc.

    More about this item

    NEP fields

    This paper has been announced in the following NEP Reports:

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:arx:papers:2405.08168. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: arXiv administrators (email available below). General contact details of provider: http://arxiv.org/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.