title: The Impact of Certificate-of-Need Laws on Nursing Home and Home Health Care Expenditures.
abstract: Over the past two decades, nursing homes and home health care agencies have been influenced by several Medicare and Medicaid policy changes including the adoption of prospective payment for Medicare-paid postacute care and Medicaid-paid long-term home and community-based care reforms. This article examines how spending growth in these sectors was affected by state certificate-of-need (CON) laws, which were designed to limit the growth of providers and have remained unchanged for several decades. Compared with states without CON laws, Medicare and Medicaid spending in states with CON laws grew faster for nursing home care and more slowly for home health care. In particular, we observed the slowest growth in community-based care in states with CON for both the nursing home and home health industries. Thus, controlling for other factors, public postacute and long-term care expenditures in CON states have become dominated by nursing homes.
authors.affiliation: Brown University, Providence, RI, USA momotazur_rahman@brown.edu.
authors.forename: Momotazur
authors.initials: M
authors.lastname: Rahman
authors.affiliation: Brown University, Providence, RI, USA.
authors.forename: Omar
authors.initials: O
authors.lastname: Galarraga
authors.affiliation: Temple University, Philadelphia PA, USA.
authors.forename: Jacqueline S
authors.initials: JS
authors.lastname: Zinn
authors.affiliation: Harvard Medical School, Boston, MA, USA.
authors.forename: David C
authors.initials: DC
authors.lastname: Grabowski
authors.affiliation: Brown University, Providence, RI, USA Providence Veterans Administration Medical Center, Health Services Research Program, Providence, RI, USA.
authors.forename: Vincent
authors.initials: V
authors.lastname: Mor
mesh_terms: D002567:Certificate of Need / Q000191:economics / Q000331:legislation & jurisprudence*; D005102:Health Expenditures / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D006699:Home Care Services / Q000191:economics* / Q000331:legislation & jurisprudence*; D006707:Homes for the Aged / Q000191:economics* / Q000331:legislation & jurisprudence*; D006801:Humans; D008134:Long-Term Care / Q000191:economics / Q000331:legislation & jurisprudence; D008484:Medicaid / Q000191:economics / Q000331:legislation & jurisprudence; D006278:Medicare / Q000191:economics / Q000331:legislation & jurisprudence; D009735:Nursing Homes / Q000191:economics* / Q000331:legislation & jurisprudence*; D014481:United States
keywords: Medicaid; Medicare; certificate of need; home health care spending; nursing home care spending