Abstract
Background
The impact of the Certificate of Need (CON) law on Emergency Department (ED) care
remains elusive in the academic literature.
Objectives
We study the impact of CON law on ED Length of Stay (LOS).
Methods
We examine ED LOS to detect any statistically significant difference between CON and
non-CON states. We then estimate the effects of CON law on ED LOS by treating CON
as an exogenous (endogenous) variable.
Results
We find that the CON legislation positively impacts ED care by reducing ED LOS (95%
confidence interval [CI] −61.3 to −10.3), and we can't reject the hypothesis that
the CON legislation can be treated as an exogenous variable in our model. An increase
in the stringency of the CON law (measured by the threshold on equipment expenditure
that is subject to a CON review) tends to diminish this positive impact on ED LOS
(95% CI 9.9–68.0). The party affiliation of the Governor (95% CI 10.3–37.5), the political
environment as a function of the agreement on voting between state senators (95% CI−64.8
to −12.9), proportion of young population (0–17 years) when compared with the elderly
(>65 years) (95% CI−2299.7 to −184.1), proportion of population covered by privately
purchased insurance (95% CI−819.3 to −59.9), etc., are found to significantly impact
ED LOS in a state.
Conclusion
This study provides a better understanding of the impact of CON law on ED care, which
extends the previous literature that has mainly focused on CON effects on inpatient
care.
Keywords
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Article info
Publication history
Published online: June 07, 2014
Accepted:
April 28,
2014
Received in revised form:
February 24,
2014
Received:
April 13,
2013
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
