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Technology Regulation Reconsidered: The Effects of Certificate of Need Policies on the Quantity and Quality of Diagnostic Imaging

Author

Listed:
  • Jill Horwitz
  • Austin Nichols
  • Carrie H. Colla
  • David M. Cutler

Abstract

Estimates of the impact of Certificate of Need laws on medical care have been inconsistent, possibly because not all CON laws apply to all services. Using an original dataset identifying imaging-related CON laws, we estimate the effects of CON on CT and MRI, using regression discontinuities at state borders. Medicare beneficiaries in regulated states are slightly less likely to receive any image and considerably less likely to receive low-value imaging than beneficiaries in non-regulated states. High-value imaging is either unaffected or declines much less. Overall, CON reduces low value care and largely leaves high value care unaffected.

Suggested Citation

  • 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.
    • Handle: RePEc:nbr:nberwo:32143
    Note: AG EH
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    References listed on IDEAS

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    1. Amitabh Chandra & Jonathan Skinner, 2012. "Technology Growth and Expenditure Growth in Health Care," Journal of Economic Literature, American Economic Association, vol. 50(3), pages 645-680, September.
    2. Stratmann, Thomas & Wille, David, 2016. "Certificate-of-Need Laws and Hospital Quality," Working Papers 06927, George Mason University, Mercatus Center.
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    5. Bingxiao Wu & Jeah Jung & Hyunjee Kim & Daniel Polsky, 2019. "Entry regulation and the effect of public reporting: Evidence from Home Health Compare," Health Economics, John Wiley & Sons, Ltd., vol. 28(4), pages 492-516, April.
    6. Polsky, Daniel & David, Guy & Yang, Jianing & Kinosian, Bruce & Werner, Rachel M., 2014. "The effect of entry regulation in the health care sector: The case of home health," Journal of Public Economics, Elsevier, vol. 110(C), pages 1-14.
    7. 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).
    8. Salkever, David S., 2000. "Regulation of prices and investment in hospitals in the United States," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 28, pages 1489-1535, Elsevier.
    9. Jonathan Roth, 2022. "Pretest with Caution: Event-Study Estimates after Testing for Parallel Trends," American Economic Review: Insights, American Economic Association, vol. 4(3), pages 305-322, September.
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    JEL classification:

    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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