Administration of Emergency Medicine EFFECT OF CERTIFICATE OF NEED LAW ON EMERGENCY DEPARTMENT LENGTH OF STAY Jomon Aliyas Paul, PHD, Huan Ni, PHD, and Aniruddha Bagchi, PHD Department of Economics, Finance and Quantitative Analysis, Kennesaw State University, Kennesaw, Georgia Reprint Address: Jomon Aliyas Paul, PHD, BB 318 Coles College of Business, Kennesaw State University, Kennesaw, GA 30144 , Abstract—Background: The impact of the Certificate of Need (CON) law on Emergency Department (ED) care re- mains elusive in the academic literature. Objectives: We study the impact of CON law on ED Length of Stay (LOS). Methods: We examine ED LOS to detect any statis- tically significant difference between CON and non-CON states. We then estimate the effects of CON law on ED LOS by treating CON as an exogenous (endogenous) vari- able. Results: We find that the CON legislation positively impacts ED care by reducing ED LOS (95% confidence in- terval [CI] À61.3 to À10.3), and we can’t reject the hypoth- esis that the CON legislation can be treated as an exogenous variable in our model. An increase in the stringency of the CON law (measured by the threshold on equipment expen- diture that is subject to a CON review) tends to diminish this positive impact on ED LOS (95% CI 9.9–68.0). The party affiliation of the Governor (95% CI 10.3–37.5), the political environment as a function of the agreement on voting between state senators (95% CIÀ64.8 to À12.9), proportion of young population (0–17 years) when compared with the elderly (>65 years) (95% CIÀ2299.7 to À184.1), proportion of population covered by privately purchased insurance (95% CIÀ819.3 to À59.9), etc., are found to significantly impact ED LOS in a state. Conclu- sion: This study provides a better understanding of the impact of CON law on ED care, which extends the previous literature that has mainly focused on CON effects on inpa- tient care. Ó 2014 Elsevier Inc. , Keywords—health policy; emergency department INTRODUCTION Background One of the fundamental elements in the analysis of the health care industry is the legal framework and related re- forms. This project focuses on studying the effects of a health care law known as the Certificate of Need (CON) on the length of stay (LOS) in the emergency department (ED). The CON laws were developed to some extent in 1972 by Social Security Amendments, but more signifi- cantly in 1974 by the National Health Planning and Resource Development Act. It is a legal document required before proposed acquisitions, expansions, or creations of facilities are allowed. The primary motiva- tion behind its enactment was to avoid unnecessary capacity (supply), control health expenditure, improve access and quality of care, and increase competition (1). This law is still in vogue in 36 states. A detailed description of the changes that CON law has undergone in various states over the years since its enactment is available in Hellinger (2). Further, studies focusing on impacts of the CON law on ED care are notably lacking, especially at the national level. Examining the effect of CON on ED is important for at least 2 reasons: 1) the ED is generally the front end of the hospital for a majority of the patient popula- tion, especially those who are uninsured; and 2) other RECEIVED: 13 April 2013; FINAL SUBMISSION RECEIVED: 24 February 2014; ACCEPTED: 28 April 2014 1 The Journal of Emergency Medicine, Vol. -, No. -, pp. 1–9, 2014 Copyright Ó 2014 Elsevier Inc. Printed in the USA. All rights reserved 0736-4679/$ - see front matter http://dx.doi.org/10.1016/j.jemermed.2014.04.027