The misguided laws contributing to America’s rural health crisis

America’s rural health care crisis continues to worsen.

More than 90% of rural counties are at risk. shortage The number of family doctors is decreasing, and many rural residents are forced to travel. time Even basic steps. Over the past 20 years, nearly 200 Rural hospitals have also been closed.hundreds more hospitals wobbling It is on the verge of bankruptcy, and millions more people are at risk of losing access to vital neighborhood health care.

In fact, the lack of adequate access to health care contributes to widening health disparities between rural and urban Americans. From 2010 to 2019, life expectancy increased in urban counties; I refused In rural areas of the country. In 2020, for example, rural counties experienced higher-than-average COVID-19 cases. mortality rate. and, Newly published research The Southern Economic Journal showed how misguided government policies are adding fuel to this fire.

We are studying certificate of need (CON) laws that require health care providers to obtain approval from state regulators before offering new services, expanding facilities, or investing in technology. Masu. CON laws currently exist in 35 states.massive evidence Although we show that these regulations limit competition in the healthcare industry and drive up prices, our study is one of the first to examine the impact of these regulations on rural America. .

Some policymakers argue that by controlling where additional health services can be provided, they can direct health care providers to increase investment in geographically remote and underserved areas. are doing. Without CON laws, the argument goes, profit-seeking providers will focus solely on urban centers.

For example, the West Virginia Department of Health, the agency that oversees West Virginia’s CON program, claim: “In West Virginia, the CON program supports small, financially vulnerable, rural hospitals and the insurance they serve by promoting availability and accessibility of services. It provides some protection to underinsured people.” The Kentucky Hospital Association does something similar. Claimwarned that repealing the CON law “would be another nail in the coffin for rural areas.”

However, this story could serve as just an excuse for existing hospitals to keep potential competitors away from the area. In many states, the CON application process is lengthy and expensive, placing a significant burden on small and new providers. In contrast, larger and more politically connected organizations are usually better able to navigate all the bureaucratic procedures.

To test these competing theories, we focus on five states that have lifted CON regulations on hospitals since the early 1990s: Nebraska, New Hampshire, North Dakota, Ohio, and Pennsylvania. , analyzed approximately 30 years of data. Relative to states that maintained CON laws, these five states experienced a 3.4% per capita increase in rural hospitals in the years following repeal. Nationally, approximately 70 hospitals will be added to serve rural patients.

Instead of worsening medical shortages in rural areas, the repeal of the CON law increased access to hospital services. Additionally, we find that the repeal of CON laws also increased the number of urban hospitals, indicating that these laws restrict beneficial competition in all regions of the country.

CON laws block the creation of new hospitals and, in doing so, exacerbate the local health crisis. Established hospitals have a strong incentive to thwart potential competitors’ CON applications in order to protect their turf, and hospital associations actively work to maintain these protections. We are doing lobbying activities.

Maureen Ohlhausen, former commissioner of the Federal Trade Commission, frankly:”[CON laws] It primarily, if not exclusively, serves to help incumbent companies fend off competition from new entrants. ” Our research supports this claim.

If policymakers want to address this crisis, repealing these anti-competitive, anti-health care consumer laws would be a good place to start.

Liam Cigo He is a graduate research fellow at George Mason University’s Mercatus Center. Vitor Melo is a senior research fellow at the West Virginia University Knee Regulation Research Center.