Subject(s)
Bipolar Disorder/economics , Bipolar Disorder/nursing , Evidence-Based Medicine/economics , Financing, Government/economics , Hospital Planning/economics , Hospitals, Psychiatric/economics , National Health Programs/economics , Cooperative Behavior , Cost-Benefit Analysis/legislation & jurisprudence , Financing, Government/legislation & jurisprudence , France , Health Services Needs and Demand/economics , Hospital Planning/legislation & jurisprudence , Humans , Interdisciplinary Communication , Secondary PreventionSubject(s)
Budgets/legislation & jurisprudence , Cost-Benefit Analysis/legislation & jurisprudence , Health Care Reform/economics , Hospital Planning/economics , Hospitalization/economics , Hospitals, Psychiatric/economics , National Health Programs/economics , Psychosomatic Medicine/economics , Psychotherapy/economics , Reimbursement Mechanisms/economics , Germany , Health Care Rationing/economics , Health Care Rationing/legislation & jurisprudence , Health Care Reform/legislation & jurisprudence , Hospital Planning/legislation & jurisprudence , Hospitalization/legislation & jurisprudence , Hospitals, Psychiatric/legislation & jurisprudence , Humans , Length of Stay/economics , Length of Stay/legislation & jurisprudence , National Health Programs/legislation & jurisprudence , Psychosomatic Medicine/legislation & jurisprudence , Psychotherapy/legislation & jurisprudence , Quality Assurance, Health Care/economics , Quality Assurance, Health Care/legislation & jurisprudence , Reimbursement Mechanisms/legislation & jurisprudenceABSTRACT
CON reforms were approved in Florida, Georgia and Iowa this year, and other states are also looking at ways to promote competition. While some observers don't see a move to sweeping change, it's a trend that draws applause. "There's no plausible argument that certificate of need meets its intended purpose. Instead, it denies access and it denies choice," says consultant Robert James Cimasi, left!
Subject(s)
Certificate of Need/legislation & jurisprudence , Hospital Design and Construction/legislation & jurisprudence , Hospital Planning/legislation & jurisprudence , State Health Plans , Connecticut , Economic Competition , Florida , Georgia , Iowa , United StatesSubject(s)
Hospital Design and Construction/trends , Hospital Planning/legislation & jurisprudence , Hospitals, Convalescent/legislation & jurisprudence , Long-Term Care/legislation & jurisprudence , Medicare/legislation & jurisprudence , Acute Disease , Centers for Medicare and Medicaid Services, U.S. , Certificate of Need , Health Care Sector/trends , Humans , Long-Term Care/economics , United StatesABSTRACT
BACKGROUND: Many states enforce Certificate of Need (CON) regulations for cardiac procedures, but little is known about how CON affects utilization. We assessed the association between cardiac CON regulations, availability of revascularization facilities, and revascularization rates. METHODS: We determined when state cardiac CON regulations were active and obtained data for Medicare beneficiaries > or = 65 years old who received coronary artery bypass graft surgery (CABG) or a percutaneous coronary intervention (PCI) between 1989 and 2002. We compared the number of hospitals performing revascularization and patient utilization in states with and without CON regulations, and in states which discontinued CON regulations during 1989 to 2002. RESULTS: Each year, the per capita number of hospitals performing CABG and PCI was higher in states without CON (3.7 per 100,000 elderly for CABG, 4.5 for PCI in 2002), compared with CON states (2.5 for CABG, 3.0 for PCI in 2002). Multivariate regressions that adjusted for market and population characteristics found no difference in CABG utilization rates between states with and without CON (P = .7). However, CON was associated with 19.2% fewer PCIs per 1000 elderly (P = .01), equivalent to 322,526 fewer PCIs for 1989 to 2002. Among most states that discontinued CON, the number of hospitals performing PCI rose in the mid 1990s, but there were no consistent trends in the number of hospitals performing CABG or in PCIs or CABGs per capita. CONCLUSIONS: Certificate of Need restricts the number of cardiac facilities, but its effect on utilization rates may vary by procedure.
Subject(s)
Angioplasty, Balloon, Coronary/statistics & numerical data , Cardiac Care Facilities/supply & distribution , Certificate of Need/legislation & jurisprudence , Coronary Artery Bypass/statistics & numerical data , Health Services Accessibility/legislation & jurisprudence , Hospital Planning/legislation & jurisprudence , State Health Plans/statistics & numerical data , Aged , Angioplasty, Balloon, Coronary/economics , Cardiac Care Facilities/statistics & numerical data , Certificate of Need/statistics & numerical data , Coronary Artery Bypass/economics , Humans , Medicare/statistics & numerical data , Regression Analysis , United StatesSubject(s)
Hospital Design and Construction/trends , Hospital Planning/trends , Hospitals, Special/supply & distribution , Centers for Medicare and Medicaid Services, U.S. , Hospital Design and Construction/legislation & jurisprudence , Hospital Planning/legislation & jurisprudence , Hospitals, Special/legislation & jurisprudence , Hospitals, Special/trends , Ownership/economics , Physicians/economics , United StatesSubject(s)
Hospital Planning/legislation & jurisprudence , Hospitals, Special/supply & distribution , Centers for Medicare and Medicaid Services, U.S. , Hospitals, General/economics , Hospitals, General/statistics & numerical data , Hospitals, Special/legislation & jurisprudence , Lobbying , Ownership , Specialties, Surgical , United StatesSubject(s)
Hospital Planning/legislation & jurisprudence , Hospital Restructuring/legislation & jurisprudence , National Health Programs/legislation & jurisprudence , Economics, Hospital/legislation & jurisprudence , Germany , Health Planning Guidelines , Health Services Needs and Demand/legislation & jurisprudence , Hospital Administration/legislation & jurisprudence , Hospital Bed Capacity , HumansSubject(s)
Hospital Planning/legislation & jurisprudence , Hospital Restructuring/legislation & jurisprudence , Hospital Shared Services/legislation & jurisprudence , National Health Programs/legislation & jurisprudence , Economic Competition/legislation & jurisprudence , Economics, Hospital/legislation & jurisprudence , Germany , Humans , Quality Assurance, Health Care/legislation & jurisprudenceABSTRACT
In states without CON laws, some local governments have been instituting their own control over hospital construction. Now a federal judge has struck down a CON ordinance in Morgan County, Ind., clearing the way for a $40 million hospital expansion project. "This experiment of trying to do (CON) at the local level won't work," says Joseph Chappelle, left, the attorney for Morgan County.