Medical Certificate of Need (CON) laws have existed since the mid-1960s. They are a classic example of government intervention and central-planning of the health care delivery system. Their stated purpose is to hold down costs and at the same time provide more charity care. They operate by requiring doctors, hospitals and clinics to receive government permission before providing more health care services in a given region. Thirty six states, including Washington, have CON laws. (here)

The argument in support of the Certificate of Need concept was that the federal government, through Medicare and Medicaid, has paid for health care in the U.S., and this funding, in turn, gave the government the justification to limit the expansion of the health care system through CON laws. The CON laws, however, artificially create monopolies and restrict access to health care for patients, leading to Congress’s repeal of the national CON law in 1987. Research also shows that CON laws do not decrease health care costs.

A recent study released by the Mercatus Center at George Mason University looked at whether CON laws provide better health care quality when compared to states without CON laws. (here)

Using a very ingenious method, the authors divided the country into hospital referral regions (HRRs) for the years 2011 through 2015. HRRs are geographic areas that are composed of two or more adjoining states with similar demographics. For example, Eastern Washington is in the same HRR as Northern Idaho and Northeastern Oregon. Washington and Oregon have CON laws whereas Idaho does not.

The authors then controlled the study and took into consideration the variables of people over the age of 65 years, the percent of non-whites, the percent of high school graduates, the percent of people without insurance, the average annual income and the percent of total hospital days used by Medicare patients.

The study concludes that CON laws do not improve health care quality. States with CON laws actually have a statistically significant higher mortality rate than states without CON laws in the same HRR. The authors also found a slightly higher (2.5 percent to 5 percent) 30 day mortality rate after hospital discharge for patients with the diagnoses of pneumonia, heart failure and heart attack in states with CON laws.

Other patient variables may be at work within HRRs, but in this very scientific, controlled study CON laws in no way improve health care quality. To increase competition, hold down costs and probably improve quality, Washington state elected officials should repeal the state’s existing CON law.