Co-author, Matthew Mitchell, 1  has identified and classified every original, peer-reviewed, empirical analysis of healthcare CON laws over the last five decades. 2  In a forthcoming publication, he will provide an exhaustive analysis of the studies. In this section, we provide a condensed version of his findings. While the bulk of the publications reviewed are academic, this analysis also includes a handful of academic-quality studies by government agencies such as the Federal Trade Commission.

Few policy experiments have been as thoroughly examined as CON laws. The review identifies 128 separate papers that contain 423 unique tests. 3  The bulk of these tests address the stated goals of CON laws: access, quality, and costs. There were also tests assessing the effects of CON laws on underserved populations, competition, provider volume, profits, and other miscellaneous outcomes such as CEO pay. 4  Though the analysis makes no judgments on the quality of the empirical tests contained in the papers, limiting the analysis to peer-reviewed material ensures a minimum quality threshold.

The following sections highlight some of the major findings. Figure 4 below shows that among 389 tests with an identifiable result. A slight majority (205 tests) associate CON laws with a “bad” outcome. These bad outcomes include higher spending, lower quality, harm to underserved populations, diminished access, or less competition. The next most common result (140 tests) is a neutral or insignificant result. A mere 44 tests (11%) associate CON laws with a “good” outcome like less spending, greater access, or higher quality. In other words, for every one test that associates CON laws with a good outcome, there are nearly five tests that associate it with a bad outcome.

Figure 4. Summary of Tests with an Obvious Normative Implication

Together, 345 out of 389 tests find that CON laws are associated with either an insignificant or bad outcome. That’s 89 percent. Economists and health researchers become increasingly confident in an outcome when many tests point in the same direction. There’s no contest here. This decisive result confirms that CON laws are not achieving their intended goals and have outlived their utility. 5  

These findings are consistent with standard economic theory, confirming CON laws operate as economists predict. CON laws are barriers to entry that protect incumbent providers from competition, increase costs, and limit access to care. Worse, the one thing protectionism should accomplish—enhancing the profits of incumbent providers—may not even occur in the long run (although it might in the short run). 6  CON laws, then, are all downside.