Georgia’s CON

Georgia’s Certificate of Need laws limit healthcare access to many in the state.

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.

The impact of CON laws

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.

October 10, 2024 • Commentary