Abstract
This paper investigates the impact of state-level Certificate-of-Need (CON) laws on COVID and non-COVID deaths in the United States during the SARS-CoV-2 pandemic. CON laws limit the expansion and acquisition of new medical services, such as new hospital beds. The coronavirus pandemic created a surge in demand for medical services, which might be exacerbated in some states that have CON laws. Our investigation focuses on mortality due to COVID and non-COVID reasons and understanding how these laws affect access to healthcare for illnesses that might require similar medical equipment to COVID patients. We find that states with high healthcare use due to COVID that reformed their CON laws during the pandemic had a reduction in mortality resulting from COVID-19, septicemia, diabetes, chronic lower respiratory disease, influenza or pneumonia, and Alzheimer’s Disease, relative to non-reforming CON states.
Highlights
The COVID-19 pandemic has put unprecedented stress on the US health care system.The true impact of COVID-19 on US mortality may be understated, as impact estimates fail to account for lives lost because of limited bed space and medical-intervention equipment such as respirators and ventilators
Many states reformed—repealed or suspended—their Certificate of Need (CON) laws to allow hospitals to quickly adjust to surges in demand for medical services. We explore whether these legal restrictions affected mortality rates due to COVID-19 and non-COVID-19 diseases and if states that reformed their CON laws mitigated pandemic-related increases in mortality
After controlling for utilization of hospital beds by COVID-19 patients, we find that in reform states, mortality due to both COVID-19, and for other causes of death whose treatments require similar resources, decreased
Summary
The COVID-19 pandemic has put unprecedented stress on the US health care system.The true impact of COVID-19 on US mortality may be understated, as impact estimates fail to account for lives lost because of limited bed space and medical-intervention equipment such as respirators and ventilators. 36 states and the District of Columbia had Certificate of Need (CON) laws, which restrict expansion of health care facilities, equipment, and service without government approval. Many states reformed—repealed or suspended—their CON laws to allow hospitals to quickly adjust to surges in demand for medical services. We explore whether these legal restrictions affected mortality rates due to COVID-19 and non-COVID-19 diseases and if states that reformed their CON laws mitigated pandemic-related increases in mortality. To analyze mortality differences in states which reformed their CON laws, we combine mortality data collected from the Centers for Disease Control and Prevention (CDC) with state-level data on hospital- and ICU-bed utilization to create a balanced-panel for midMarch through June 2020.
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