Georgians don’t always have it easy when it comes to accessing quality healthcare. Given the level of uncertainty and anxiety the healthcare landscape can inspire, it is important to understand the biggest barriers to access. One such barrier is the preservation of certificate of need (CON) laws.
The Georgia Public Policy Foundation’s recently-published study of CON laws assesses the effect on availability of care. Access to healthcare is the most-studied aspect of CON laws. Since CON is designed to limit the supply of technology and investment, it is intuitive that those regulations would also limit the availability of services.
The study’s findings overwhelmingly support this assumption.
Healthcare “availability” can mean a few different things, and this study uses multiple techniques to measure it. Some tests counted the number of service providers per capita, and some counted units of medical technology per capita. Others measured how far patients must travel to obtain care or how long patients must wait until they can be served.
Of the 72 tests that assess CON’s effect on availability services, 59 (or 82%) were associated with diminished availability, while nine demonstrated neutral outcomes and only four showed greater availability. However, one of the four positive tests was interpreted as negative by its author, and the others also found negative associations in other circumstances.
Controlling for other possibly-confounding factors, researchers find that the average patient in a state that maintains CON regulations has access to:
- 30 to 48 percent fewer hospitals;
- 14 percent fewer ambulatory surgery centers (ASCs);
- 30 percent fewer rural hospitals;
- 13 percent fewer rural ASCs;
- 25 percent fewer open-heart surgery programs;
- 46 percent fewer facilities offering coronary artery bypass graft (CABG);
- 20 percent fewer psychiatric care facilities;
- 50 percent fewer home health agencies;
- fewer hospitals offering revascularization;
- fewer dialysis clinics;
- fewer hospitals per cancer incident;
- fewer neonatal intensive care units (NICU); and
- fewer alcohol and drug abuse facilities.
Patients in CON states have access to fewer medical imaging devices and fewer hospital beds. They face longer wait times, must typically travel farther to obtain care and are more likely to leave their states for care.
The question of whether CON lives up to its promise to ensure an adequate supply of healthcare services is one of the most studied aspects of the issue, and it produces some of the most lopsided results. CON is decisively shown to be a barrier to healthcare access.
