Duke University Center for Health Policy and Inequalities Research, 310 Trent Drive, Durham, NC, 27710, USA.
Department of Economics, Providence College, 1 Cunningham Sq, Providence, RI, 02918, USA.
BMC Health Serv Res. 2020 Aug 14;20(1):748. doi: 10.1186/s12913-020-05563-1.
Certificate of Need (CON) laws, currently in place in 35 US states, require certain health care providers to obtain a certification of their economic necessity from a state board before opening or undertaking a major expansion. We conduct the first systematic review and cost-effectiveness analysis of these laws.
We review 90 articles to summarize the evidence on how certificate of need laws affect regulatory costs, health expenditures, health outcomes, and access to care. We use the findings from the systematic review to conduct a cost-effectiveness analysis of CON.
The literature provides mixed results, on average finding that CON increases health expenditures and overall elderly mortality while reducing heart surgery mortality. Our cost-effectiveness analysis estimates that the costs of CON laws somewhat exceed their benefits, although our estimates are quite uncertain.
The literature has not yet reached a definitive conclusion on how CON laws affect health expenditures, outcomes, or access to care. While more and higher quality research is needed to reach confident conclusions, our cost-effectiveness analysis based on the existing literature shows that the expected costs of CON exceed its benefits.
需求证明（CON）法目前在美国 35 个州实施，要求某些医疗保健提供者在开设或进行重大扩张之前，从州委员会获得其经济必要性的证明。我们对这些法律进行了首次系统评价和成本效益分析。
我们回顾了 90 篇文章，总结了关于需求证明法如何影响监管成本、卫生支出、健康结果和获得医疗服务的证据。我们利用系统评价的结果对 CON 进行成本效益分析。
文献提供了混合的结果，平均发现 CON 增加了卫生支出和整体老年人口死亡率，同时降低了心脏手术死亡率。我们的成本效益分析估计，CON 法的成本略高于其收益，尽管我们的估计非常不确定。
文献尚未就 CON 法如何影响卫生支出、结果或获得医疗服务得出明确结论。虽然需要更多和更高质量的研究来得出有信心的结论，但我们基于现有文献的成本效益分析表明，CON 的预期成本超过了其收益。
