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  • Title: Certificate of need and the cost of competition in home healthcare markets.
    Author: Ettner SL, Zinn JS, Xu H, Ladd H, Nuccio E, Sorkin DH, Mukamel DB.
    Journal: Home Health Care Serv Q; 2020; 39(2):51-64. PubMed ID: 32058854.
    Abstract:
    We used 2010-16 Medicare Cost Reports for 10,737 freestanding home health agencies (HHAs) to examine the impact of home health (HH) and nursing home (NH) certificate-of-need (CON) laws on HHA caseload, total and per-patient variable costs. After adjusting for other HHA characteristics, total costs were higher in states with only HH CON laws ($2,975,698), only NH CON laws ($1,768,097), and both types of laws ($3,511,277), compared with no CON laws ($1,538,536). Higher costs were driven by caseloads, as CON reduced per-patient costs. Additional research is needed to distinguish whether this is due to skimping on quality vs. economies of scale.
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