Another legislative purpose for CON laws is to improve the quality of healthcare. 1  Yet CON laws only serve an initial gatekeeping function. While applicants may attest that they will offer quality services during the application process, the Cabinet does not follow up on quality concerns. Instead, quality requirements in Kentucky are monitored and enforced by the Office of Inspector General, Division of Health Care under its facility licensure authority. 2  

It’s unsurprising then that the overwhelming majority of the existing tests show that CON laws lead to worse care or have neutral/insignificant effects on quality. Of 98 tests, only ten associate CON laws with improved quality.

Figure 7. Tests Assessing the Effect of CON on Quality of Care

States with CON laws have:

  • Higher mortality rates for heart attack, heart failure, and pneumonia, 3
  • Higher mortality rates for natural death, septicemia, diabetes, chronic lower respiratory disease, influenza or pneumonia, Alzheimer’s, and COVID-19, 4  
  • Higher readmission rates following heart attack, heart failure, and pneumonia, 5  and
  • Lower nursing staff-to-patient ratios and greater use of physical force in nursing homes. 6  

States without CON laws have an estimated 5.7% fewer deaths from post-surgical complications due to the mortality rates highlighted above.