Abstract
Certificate-of-need (CON) laws are intended to restrain health care spending by limiting the acquisition of duplicative capital and the initiation of unnecessary services. Critics contend that need is difficult to objectively assess, especially considering the risks and uncertainty inherent in health care. We compare statewide bed utilization rates and hospital-level bed utilization rates in bed CON and non-bed CON states during the COVID-19 pandemic. Controlling for other possibly confounding factors, we find that states with bed CONs had 12 percent higher bed utilization rates and 58 percent more days in which more than 70 percent of their beds were used. Individual hospitals in bed CON states were 27 percent more likely to utilize all of their beds. States that relaxed CON requirements to make it easier for hospitals to meet the surge in demand did not experience any statistically significant decreases in bed utilization or number of days above 70 percent of capacity. Nor were hospitals in states that relaxed their CON requirements any less likely to use all their beds. Certificate-of-need laws seem to have exacerbated the risk of running out of beds during the COVID-19 pandemic. State efforts to relax these rules had little immediate effect on reducing this risk.
Highlights
We investigate the effects of one capacity constraint—certificate-of-need (CON) regulations that limit the supply of hospital beds in 27 states
We focus on adult inpatient beds, which include all “staffed inpatient adult beds in the hospital including all overflow and active surg[ery]/expansion beds used for inpatients reported during the 7-day period”
The regulation is intended to limit the acquisition of expensive, unneeded medical equipment, but research suggests that it limits access, throttles competition, and undermines quality
Summary
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. In states with certificate-of-need requirements in health care, providers wishing to open or expand their facilities must first prove to a regulator that their community needs the service they plan to perform or the equipment they plan to acquire. In New. York City, for example, a group of Hasidic women recently attempted to start an all-female ambulance service that would cater to the particular desire for women in their community for modesty and privacy in medical matters. We study hospital bed utilization throughout the pandemic, certificate-of-need laws in general, and bed CONs in particular. Hospitals in these states were more likely to use all of their beds.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
