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> In order to open a new hospital in most jurisdictions, by law you need the permission of other local hospitals That doesn't really have much of an effect the

> In order to open a new hospital in most jurisdictions, by law you need the permission of other local hospitals That doesn't really have much of an effect these days, though, because if anything, we already have an excess of hospitals in most areas where this would come into effect. That's why hospitals have been hemorrhaging money, and so many have either gone broke and closed up entirely or been consolidated into larger hospital systems. The independent hospital is a dying breed, and it's been dying for a very long time. In other words, there just simply isn't really any appreciable desire to open hospitals in those regions. The Certificate of Need isn't the limiting factor; their ability to break even on their operating expenses is.

dbatten 9y ago
Really? I can't speak for the country as a whole, but in my area (Raleigh/Durham, NC) the major healthcare providers have been battling each other for years over when, where, and what types of new hospitals they can open. These laws have been and continue to be central to the fight. Just a few days ago: http://www.newsobserver.com/news/business/article188329569.html http://www.newsobserver.com/news/business/article188329569.h...
pg_bot 9y ago
If you take the time to look at the research you will find that it does have an effect.[0] Here is the money quote from that article "More likely, CON has affected the intensity and speed with which hospitals pursue particular construction activities. For example, the absence of CON in Indianapolis is likely an important factor in its rapid build-up of new full-service hospitals and specialty facilities. In Seattle, where CON is present, multiple hospital organizations are seeking to build new facilities in population-growth areas, but they must await review and final approval. CON requirements in this community could explain why Seattle hospitals expressed greater interest in better management of their existing capacity in the face of growing demand, because they cannot move quickly to build more capacity." Anecdotally, there has been a 10 year long fight near where I live over opening a hospital with CON laws being at the center of state supreme court litigation[1] As someone who works in healthcare and understands the economics of the system your perception cannot be further from reality. [0]https://www.healthaffairs.org/doi/full/10.1377/hlthaff.25.3.783 https://www.healthaffairs.org/doi/full/10.1377/hlthaff.25.3.... [1] http://www.charlotteobserver.com/news/local/article126222794.html http://www.charlotteobserver.com/news/local/article126222794...
- chimeracoder 9y ago
  > As someone who works in healthcare and understands the economics of the system your perception cannot be further from reality. As someone who's also worked in healthcare and also has an actual degree in economics, I stand by my point. In general, the CoN requirement doesn't have much of an end impact on prices for patients.
  - pg_bot 9y ago
    I too have a degree in both Math and Economics. I started a medical clinic with the goal of reducing the cost of healthcare in the US by 50%. Our patients' out of pocket expenses for primary care are less than a typical cell phone bill on a per month basis. All of our prices are transparent and available up front. I know a bit about reducing costs. However, I will not fall back on my credentials since I prefer evidence instead of grandstanding. Here are a few links that I think could help change your mind. https://www.mercatus.org/system/files/mercatus-mitchell-con-healthcare-spending-v1a.pdf https://www.mercatus.org/system/files/mercatus-mitchell-con-... http://www.econtalk.org/archives/2012/11/cochrane_on_hea.html http://www.econtalk.org/archives/2012/11/cochrane_on_hea.htm... http://www.econtalk.org/archives/2017/10/michael_munger_4.html http://www.econtalk.org/archives/2017/10/michael_munger_4.ht... I've excerpted the following quote from the first link as I think it summarizes my viewpoint quite well. "A review of 19 peer-reviewed academic studies finds that CON laws have worked largely as economic theory predicts and that they have failed to achieve their stated goal of cost reduction. The overwhelming weight of evidence suggests that CON laws are associated with both higher per unit costs and higher total expenditures. The evidence is mixed on whether CON laws have increased the efficiency of particular hospitals by channeling more patients through fewer facilities, and there is no evidence that CON decreased overall investment as its proponents had hoped. The weight of evidence suggests that CON regulations persist because they protect politically potent special interests from competition"

dbatten 9y ago

Really? I can't speak for the country as a whole, but in my area (Raleigh/Durham, NC) the major healthcare providers have been battling each other for years over when, where, and what types of new hospitals they can open. These laws have been and continue to be central to the fight. Just a few days ago: http://www.newsobserver.com/news/business/article188329569.html http://www.newsobserver.com/news/business/article188329569.h...

pg_bot 9y ago

If you take the time to look at the research you will find that it does have an effect.[0] Here is the money quote from that article "More likely, CON has affected the intensity and speed with which hospitals pursue particular construction activities. For example, the absence of CON in Indianapolis is likely an important factor in its rapid build-up of new full-service hospitals and specialty facilities. In Seattle, where CON is present, multiple hospital organizations are seeking to build new facilities in population-growth areas, but they must await review and final approval. CON requirements in this community could explain why Seattle hospitals expressed greater interest in better management of their existing capacity in the face of growing demand, because they cannot move quickly to build more capacity." Anecdotally, there has been a 10 year long fight near where I live over opening a hospital with CON laws being at the center of state supreme court litigation[1] As someone who works in healthcare and understands the economics of the system your perception cannot be further from reality. [0]https://www.healthaffairs.org/doi/full/10.1377/hlthaff.25.3.783 https://www.healthaffairs.org/doi/full/10.1377/hlthaff.25.3.... [1] http://www.charlotteobserver.com/news/local/article126222794.html http://www.charlotteobserver.com/news/local/article126222794...

chimeracoder 9y ago
> As someone who works in healthcare and understands the economics of the system your perception cannot be further from reality. As someone who's also worked in healthcare and also has an actual degree in economics, I stand by my point. In general, the CoN requirement doesn't have much of an end impact on prices for patients.
- pg_bot 9y ago
  I too have a degree in both Math and Economics. I started a medical clinic with the goal of reducing the cost of healthcare in the US by 50%. Our patients' out of pocket expenses for primary care are less than a typical cell phone bill on a per month basis. All of our prices are transparent and available up front. I know a bit about reducing costs. However, I will not fall back on my credentials since I prefer evidence instead of grandstanding. Here are a few links that I think could help change your mind. https://www.mercatus.org/system/files/mercatus-mitchell-con-healthcare-spending-v1a.pdf https://www.mercatus.org/system/files/mercatus-mitchell-con-... http://www.econtalk.org/archives/2012/11/cochrane_on_hea.html http://www.econtalk.org/archives/2012/11/cochrane_on_hea.htm... http://www.econtalk.org/archives/2017/10/michael_munger_4.html http://www.econtalk.org/archives/2017/10/michael_munger_4.ht... I've excerpted the following quote from the first link as I think it summarizes my viewpoint quite well. "A review of 19 peer-reviewed academic studies finds that CON laws have worked largely as economic theory predicts and that they have failed to achieve their stated goal of cost reduction. The overwhelming weight of evidence suggests that CON laws are associated with both higher per unit costs and higher total expenditures. The evidence is mixed on whether CON laws have increased the efficiency of particular hospitals by channeling more patients through fewer facilities, and there is no evidence that CON decreased overall investment as its proponents had hoped. The weight of evidence suggests that CON regulations persist because they protect politically potent special interests from competition"