Access is the most-studied effect of CON laws. By design, CON regulations limit the supply of facilities, technology, and investment. Thus, it seems intuitive that they would reduce the availability of services. Yet, vexingly, one purpose of Kentucky’s CON laws is to “increase access to health-care facilities, services, and providers.” 1 The authors of this legislation evidently believed that by limiting the supply of certain services and procedures, they could increase the supply in other areas.
The data suggest otherwise. A total of 170 tests examine whether CON laws impede or enhance access to care, and 153 (or 90%) find that CON laws impede access to care or have a neutral or insignificant effect on access. For every test associating CON laws with increased access, there are more than five associating it with diminished access. The weight of the evidence is undeniable.
These tests largely fall into two categories: “availability tests” and “utilizations tests.”
Availability Tests
Availability tests assess how easy it is for patients to obtain care. They measure things like the number of providers or services per capita, or the units of technology per capita. Other availability tests assess how far patients must travel to find care, while still others assess how long they must wait once they get there. In total, there have been 80 tests assessing the effect of CON laws on the availability of care. As shown in Figure 5, 79% of these tests associate CON laws with diminished availability of care, while just 8% associate them with increased availability.
Figure 5. Tests Assessing the Effect of CON on Availability of Services
Among other things, researchers find that patients in states with CON laws have:
- 30–48% fewer hospitals, 2
- 30% fewer rural hospitals and 13% fewer rural ambulatory surgical centers, 3
- 25% fewer open-heart surgery programs, 4
- 20% fewer psychiatric care facilities, 5 and
- Fewer dialysis clinics and reduced capacity at existing clinics. 6
Several studies also associate CON laws with fewer hospital beds. 7
For example, one study finds that each additional service covered by CON reduces the number of hospital beds per 100,000 persons by 4.7%. 8
And, patients in states with CON laws have access to fewer medical imaging devices, 9
must wait longer for care, 10
must travel farther for care, 11
and are more likely to leave their state for care. 12
Utilization Tests
Another way to measure access is to look at the actual utilization of services. Here, the theoretical effect of CON laws is less clear because patients will often seek care even if it is costly or inconvenient. It is also possible that CON laws could increase utilization of certain services by suppressing utilization of other services. For example, if a condition can be treated by either procedure A or procedure B, but procedure A is limited by a CON, we would expect to see the number of users of procedure A decrease and the number of users of procedure B increase.
We have identified 90 tests that measure whether CON laws affect the utilization of healthcare services. Of these, 79 tests find either no significant relationship or a negative relationship between CON laws and utilization of services. Only 11 tests associate CON with greater utilization of services. Thus, there is little support for the proposition that CON laws increase the utilization of care.
Figure 6. Tests Assessing the Effect of CON on Utilization of Services
