title: Effect of certificate of need law on emergency department length of stay.
abstract: BACKGROUND
  The impact of the Certificate of Need (CON) law on Emergency Department (ED) care remains elusive in the academic literature.
  
  
  OBJECTIVE
  We study the impact of CON law on ED Length of Stay (LOS).
  
  
  METHODS
  We examine ED LOS to detect any statistically significant difference between CON and non-CON states. We then estimate the effects of CON law on ED LOS by treating CON as an exogenous (endogenous) variable.
  
  
  RESULTS
  We find that the CON legislation positively impacts ED care by reducing ED LOS (95% confidence interval [CI] -61.3 to -10.3), and we can't reject the hypothesis that the CON legislation can be treated as an exogenous variable in our model. An increase in the stringency of the CON law (measured by the threshold on equipment expenditure that is subject to a CON review) tends to diminish this positive impact on ED LOS (95% CI 9.9-68.0). The party affiliation of the Governor (95% CI 10.3-37.5), the political environment as a function of the agreement on voting between state senators (95% CI-64.8 to -12.9), proportion of young population (0-17 years) when compared with the elderly (>65 years) (95% CI-2299.7 to -184.1), proportion of population covered by privately purchased insurance (95% CI-819.3 to -59.9), etc., are found to significantly impact ED LOS in a state.
  
  
  CONCLUSIONS
  This study provides a better understanding of the impact of CON law on ED care, which extends the previous literature that has mainly focused on CON effects on inpatient care.
authors.affiliation: Department of Economics, Finance and Quantitative Analysis, Kennesaw State University, Kennesaw, Georgia.
authors.forename: Jomon Aliyas
authors.initials: JA
authors.lastname: Paul
authors.affiliation: Department of Economics, Finance and Quantitative Analysis, Kennesaw State University, Kennesaw, Georgia.
authors.forename: Huan
authors.initials: H
authors.lastname: Ni
authors.affiliation: Department of Economics, Finance and Quantitative Analysis, Kennesaw State University, Kennesaw, Georgia.
authors.forename: Aniruddha
authors.initials: A
authors.lastname: Bagchi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002567:Certificate of Need / Q000331:legislation & jurisprudence*; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D036262:Empirical Research; D005260:Female; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
keywords: emergency department; health policy