Certificate-of-need laws that govern the construction and development of health care facilities do not raise the quality of care at hospitals and may even lead to more readmissions, a new study found.
The study published Tuesday by the conservative Mercatus Center at George Mason University found that hospitals in the 35 states with CON laws provide lower-quality services.
Specifically, rates for pneumonia, heart failure, and heart attacks are significantly higher in these hospitals, as were deaths from complications after surgery.
CON laws require owners of healthcare facilities to prove public need to obtain permission from a state agency to establish new healthcare facilities, devices and services. The idea behind CON programs is that too much capacity can lead to higher health care price inflation, as hospitals raise prices to make up for empty beds, according to the National Conference of State Legislatures.
New Hampshire recently became the 15th state to repeal its CON program.
Supporters of CON programs say the requirements improve hospital quality as providers are able to practice on more patients and improve their skills due to less competition in the market. The Mercatus study's results, however, negate that theory.
Using data from the Hospital Compare website, researchers analyzed the effect of CON laws on metrics for nine different quality indicators at more than 900 hospitals from 2011 to 2015. Quality indicators included surgical complications, patient survey results, readmission rates and mortality rates for different conditions.
“We find that nearly all the quality measures are statistically significantly worse in CON states than in non-CON states,” the study reads. Hospitals in states with CON laws performed worse than those in non-CON states on eight of the nine measures.
For example, compared with hospitals in states without CON laws, hospitals in states with the laws have on average over 0.5 percentage points more pneumonia and heart failure patient readmissions. That means there are about five additional readmissions per 1,000 patient discharges at hospitals in CON states.
Deaths following treatable surgical complications showed the largest difference for all measures. The mortality rate from complications in hospitals in CON states is about 5.5% higher compared with non-CON states, or an average of six more deaths per 1,000 patient discharges.
However, CON states did perform better than non-CON states when looking at post-surgery development of pulmonary embolism by about four cases per 1,000 patient discharges.
The study notes that age, income, education and ethnicity factors do not change the results because researchers focused on hospital referral regions where those factors weren't significantly different on the CON state versus non-CON state side of the border.
