Working Paper: NBER ID: w19801
Authors: Jill R. Horwitz; Daniel Polsky
Abstract: Certificate of Need Laws (CON), state laws requiring providers to obtain licenses before adopting healthcare technology, have been controversial. The effect of CON on technology supply has not been well established. In part this is because analyses have focused on state-level supply effects, which may reflect either the consequence of CON regulation on supply or the cause for its adoption or retention. Instead, we focus on the cross-border effects of CON. We compare the number and location of magnetic resonance imaging providers in counties that border states with a different regulatory regime to: 1) counties in the interior of states, 2) counties on state borders with the same regulatory regime on both sides, and 3) counties on borders with different regulatory regimes, but with a large river on the border. We find there are 6.4 fewer MRIs per million people in regulated counties that border counties in unregulated states than in unregulated counties that border regulated counties. This statistically significant finding that regulatory spillover can be sizable should be accounted for in future research on state-based health technology regulation. In addition, it suggests state experiences may not accurately predict the effects of CON if it were implemented nationally.
Keywords: Certificate of Need; Health Technology Regulation; MRI Providers; Cross-Border Effects
JEL Codes: H70; I11; I18; K32; L1; L52
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| CON regulations (K20) | MRI provider locations (R15) |
| unregulated counties bordering regulated states (K23) | MRI provider locations (R15) |
| regulatory environment (G38) | MRI provider locations (R15) |
| border effects (F55) | MRI provider locations (R15) |