Address correspondence to Vivian Ho, Ph.D., Department of Economics, James A. Baker III Institute for Public Policy, Rice University, MS 40, 6100 Main St., Houston, TX 77005; e-mail: email@example.com. Vivian Ho, Ph.D., is also at the Department of Medicine, Baylor College of Medicine, Houston, TX. Meei-Hsiang Ku-Goto, M.A., is at the James A. Baker III Institute for Public Policy, Rice University, Houston, TX. James G. Jollis, M.D., Echocardiography Laboratory, Division of Cardiovascular Medicine, Duke University Medical Center, Durham, NC.
Certificate of Need (CON) for Cardiac Care: Controversy over the Contributions of CON
Article first published online: 16 DEC 2008
© Health Research and Educational Trust
Health Services Research
Volume 44, Issue 2p1, pages 483–500, April 2009
How to Cite
Ho, V., Ku-Goto, M.-H. and Jollis, J. G. (2009), Certificate of Need (CON) for Cardiac Care: Controversy over the Contributions of CON. Health Services Research, 44: 483–500. doi: 10.1111/j.1475-6773.2008.00933.x
- Issue published online: 12 MAR 2009
- Article first published online: 16 DEC 2008
- Certificate of need;
- panel data methods
Objectives. To test whether state Certificate of Need (CON) regulations influence procedural mortality or the provision of coronary artery bypass graft surgery (CABG) and percutaneous coronary interventions (PCI).
Data Sources. Medicare inpatient claims obtained for 1989–2002 for patients age 65+ who received CABG or PCI.
Study Design. We used differences-in-differences regression analysis to compare states that dropped CON during the sample period with states that kept the regulations. We examined procedural mortality, the number of hospitals in the state performing CABG or PCI, mean hospital volume, and statewide procedure volume for CABG and PCI.
Principal Findings. States that dropped CON experienced lower CABG mortality rates relative to states that kept CON, although the differential is not permanent. No such mortality difference is found for PCI. Dropping CON is associated with more providers statewide and lower mean hospital volume for both CABG and PCI. However, statewide procedure counts remain the same.
Conclusions. We find no evidence that CON regulations are associated with higher quality CABG or PCI. Future research should examine whether the greater number of hospitals performing revascularization after CON removal raises expenditures due to the building of more facilities, or lowers expenditures due to enhanced price competition.