One of the earliest efforts to curb needless health care spending in the United States
was certificate-of-need (CON) programs, which limit and manage the expansion of different
health care institutions. CON programs mainly targeted nursing homes and home health
industry that provide long-term care that is predominantly financed by states through
Medicaid program. A large set of empirical studies documented that CON laws have been
unsuccessful in limiting growth of hospital,
1
,2
nursing home,
3
,4
and home health
5
,6
spending. Despite this lack of evidence on the effectiveness of CON programs, 34
states have some form of CON programs that remained mostly unchanged over the last
3 decades. Such long-term presence of CON laws raises an important concern that CON
imposes a barrier to entry and diminishes the threat of competition for incumbents
that may affect the quality of care.
7
Thus, nursing homes in states with and without CON laws may have been in 2 very different
competitive atmospheres over time.To read this article in full you will need to make a payment
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References
- State-regulation and hospital costs.Rev Econ Stat. 1995; 77: 416-422
- Does removing certificate-of-need regulations lead to a surge in health care spending?.J Health Polit Policy Law. 1998; 23: 455-481
- Testing for excess demand in nursing home care markets.Med Care. 1993; 31: 680-693
- The effects of CON repeal on Medicaid nursing home and long-term care expenditures.Inquiry. 2003; 40: 146-157
- Use of Medicaid 1915 (c) home- and community-based care waivers to reconfigure state long-term care systems.Med Care Res Rev. 2001; 58: 100-119
- Access to community-based long-term care: Medicaid’s role.J Aging Health. 2002; 14: 138-159
- The impact of certificate-of-need laws on nursing home and home health care expenditures.Med Care Res Rev. 2016; 73: 85-105
- Certificate of need state laws.(Available at:) (Accessed September 1, 2018)
References
- Nursing home caregiver staffing levels and quality of care—A literature review.J Appl Gerontol. 2008; 27: 375-405
- Caregiver staffing in nursing homes and their influence on quality of care using dynamic panel estimation methods.Med Care. 2011; 49: 545-552
Article info
Publication history
Published online: November 05, 2019
Footnotes
This work was supported by the National Institute on Aging grants R03 AG054687 (PI: Momotazur Rahman) and R21 AG053712 (PI: Momotazur Rahman).
The authors declare no conflicts of interest.
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© 2019 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
