Effect of Certificate of Need Law on the Intensity of Competition: The Market for Emergency Care

Document Type


Publication Date

January 2017


Purpose: This article aims to contribute to the academic literature in better understanding the impact of Certificate of Need (CON) Law on Emergency Department (ED) care. Impact of CON Law on ED competition remains an unanswered empirical question.Methods: We examine the impact of CON Law and its stringency on the intensity of competition (rivalry among competitors) between ED measured by the Herfindahl-Hirschman Index (HHI). We then estimate the effects of CON Law on HHI by treating CON as an exogenous (endogenous) variable. Findings: On average the CON legislation enhances ED competition. A possible reason is that the law hinders predatory behavior, and therefore acts as an effective anti-trust tool. Other findings indicate that competition is found to be positively related to a state’s population size and median income and negatively related with the prevalence of employer provided insurance and magnitude of illegal immigration in a state. Practical Implications: This article adds to our understanding of why so many states still retain the law even though they have the option to repeal it.Originality: Our analysis of impact of CON regulation on ED competition significantly contributes to the healthcare and strategy literature noting that healthcare is a highly regulated industry and because the law potentially serves as an anti-trust tool in the hands of the government. We extend the empirical literature by treating CON Law and its stringency as exogenous (endogenous). Our comprehensive analysis considers a host of control variables such as population demographics, their health status and access to health care, political environment, in addition to the CON features.

Journal Title

Socio-Economic Planning Sciences