Posted on March 2, 2004 at 10:02 a.m.

BIRMINGHAM, AL — Certificate of need laws lead to improved patient outcomes for some procedures, according to a study by Vivian Ho, Ph.D., associate professor of public health with the department of health care organization and policy at the University of Alabama at Birmingham (UAB). Details of the study are published in the March 2004 issue of the American Heart Journal.

Certificate of need laws aim to control health care costs by restricting the duplication of medical facilities and services in a market area. Regulators believe the laws also improve patient outcomes by increasing the volume of certain procedures performed by existing providers. However, until now, this premise had not been fully evaluated.

States such as Florida that have certificate of need laws have fewer hospitals and higher patient volumes per hospital than states such as California that have no such laws. “Certificate of need laws have received a lot of attention in recent years because they restrict potential health care providers from entering a highly profitable market,” Ho said.

The study compared the outcomes of patients undergoing a heart procedure called angioplasty in Florida with the outcomes of angioplasty patients in California. “Patients in Florida fared moderately better, supporting an association between higher procedure volumes and better patient outcomes,” Ho said.

Analysis was based on 292,457 hospital admissions in Florida and 390,880 hospital admissions in California for angioplasty from 1988 to 1998. “In 1988, there was not a significant difference in the average number of angioplasty procedures performed per hospital in Florida versus the average number of procedures performed per hospital in California,” Ho said. “However, by 1998, Florida hospitals on average were performing significantly more angioplasty procedures than California hospitals.”

Ho calculated the percentage of inpatient deaths and the percentage of emergency bypass heart surgeries performed on patients admitted for angioplasty as indicators of patient outcomes. “The inpatient death rate was the same — 1.4 percent — for hospitals in both states,” Ho said. “However, the rate of emergency bypass heart surgeries was slightly lower in Florida than in California — 2 percent in Florida and 2.2 percent in California.”

Further research is needed. “Although the study clearly points to an association between improved quality of care and certificate of need laws, it’s important to consider how this might impact access to care in sparsely populated areas that can’t support a hospital large enough to win certificate of need approval,” Ho said.

Also, the study points out that there is now a higher propensity to receive angioplasty in Florida than in California. “This may be a disturbing side effect of certificate of need laws,” Ho said. “If hospitals are required to perform a minimum number of procedures for certificate of need approval, they may become more inclined to perform a certain procedure on patients who they would have treated differently otherwise.”