Impact of US state government regulation on patient access to elective surgical care

Rising health care costs in the United States have led to government regulation of services via a Certificate of Need (CON) law in many states. Such regulation may decrease access to elective surgical procedures. This study describes the impact of CON laws on elective surgical care.

This retrospective cohort trial used data from the Health Care Utilization Project, a publicly available, inpatient database. Rates of six elective procedures were compared between 21 CON states and 5 non-CON states (2004-2005). Further, facility type (non-profit versus for-profit), facility teaching status, and median charges were also compared as a function of CON status. Statistical analysis was performed by Student's t-tests (?=0.05).

CON laws did not affect procedure rates (P = 0.11-0.97), but lower charges were found for lumbar discectomy ($16,819 versus $13,493 p=0.04), acoustic neuroma resection ($60,993 versus $46,353, P < 0.001), and microvascular decompression (MVD) for trigeminal neuralgia ($37,741 versus $27,729, P < 0.001) in CON states. Various procedures exhibited a shift from for-profit to non-profit facilities including lumbar disectomy (20% versus 9%, P=0.01), acoustic neuroma resection (5.5% versus 0.2%, P=0.03), MVD (20% versus 3%, P=0.02), and rotator cuff repair (23% versus 10%, P=0.01). CON status had no effect on proportion of cases occurring at teaching facilities.

CON laws appear to maintain patient access to elective surgical care while successfully reducing hospital charges. The location of surgery may shift to non-profit centers suggesting preferential certificate distribution, though this only partly explains the decreased charges in states with CON regulation.