Ho Vivian, Ku-Goto Meei-Hsiang, Jollis James G
Department of Economics, James A. Baker III Institute for Public Policy, Rice University, Houston, TX 77005, USA.
Health Serv Res. 2009 Apr;44(2 Pt 1):483-500. doi: 10.1111/j.1475-6773.2008.00933.x. Epub 2008 Dec 15.
To test whether state Certificate of Need (CON) regulations influence procedural mortality or the provision of coronary artery bypass graft surgery (CABG) and percutaneous coronary interventions (PCI).
Medicare inpatient claims obtained for 1989-2002 for patients age 65+ who received CABG or PCI.
We used differences-in-differences regression analysis to compare states that dropped CON during the sample period with states that kept the regulations. We examined procedural mortality, the number of hospitals in the state performing CABG or PCI, mean hospital volume, and statewide procedure volume for CABG and PCI.
States that dropped CON experienced lower CABG mortality rates relative to states that kept CON, although the differential is not permanent. No such mortality difference is found for PCI. Dropping CON is associated with more providers statewide and lower mean hospital volume for both CABG and PCI. However, statewide procedure counts remain the same.
We find no evidence that CON regulations are associated with higher quality CABG or PCI. Future research should examine whether the greater number of hospitals performing revascularization after CON removal raises expenditures due to the building of more facilities, or lowers expenditures due to enhanced price competition.
检验州医疗需求证书（CON）法规是否会影响手术死亡率或冠状动脉搭桥术（CABG）及经皮冠状动脉介入治疗（PCI）的实施情况。
获取了1989 - 2002年65岁及以上接受CABG或PCI治疗患者的医疗保险住院理赔数据。
我们采用双重差分回归分析，将样本期内取消CON的州与保留该法规的州进行比较。我们考察了手术死亡率、该州进行CABG或PCI的医院数量、医院平均手术量以及CABG和PCI的全州手术量。
与保留CON的州相比，取消CON的州CABG死亡率较低，不过这种差异并非永久性的。PCI未发现此类死亡率差异。取消CON与全州更多的医疗服务提供者以及CABG和PCI的较低医院平均手术量相关。然而，全州手术量总数保持不变。
我们没有发现证据表明CON法规与更高质量的CABG或PCI相关。未来的研究应考察取消CON后进行血运重建的医院数量增加是否会因更多设施建设而增加支出，或者是否会因价格竞争加剧而降低支出。
