{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,3,14]],"date-time":"2025-03-14T04:26:27Z","timestamp":1741926387567,"version":"3.38.0"},"reference-count":0,"publisher":"University of Toronto Press Inc. (UTPress)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinical and Investigative Medicine"],"published-print":{"date-parts":[[2008,10,1]]},"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p> Rising health care costs in the United States have led to government regulation of services via a Certificate of Need (CON) law in many states. Such regulation may decrease access to elective surgical procedures. This study describes the impact of CON laws on elective surgical care. <\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p> This retrospective cohort trial used data from the Health Care Utilization Project, a publicly available, inpatient database. Rates of six elective procedures were compared between 21 CON states and 5 non-CON states (2004-2005). Further, facility type (non-profit versus for-profit), facility teaching status, and median charges were also compared as a function of CON status. Statistical analysis was performed by Student\u2019s t-tests (?=0.05). <\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p> CON laws did not affect procedure rates (P = 0.11-0.97), but lower charges were found for lumbar discectomy ($16,819 versus $13,493 p=0.04), acoustic neuroma resection ($60,993 versus $46,353, P &lt; 0.001), and microvascular decompression (MVD) for trigeminal neuralgia ($37,741 versus $27,729, P &lt; 0.001) in CON states. Various procedures exhibited a shift from for-profit to non-profit facilities including lumbar disectomy (20% versus 9%, P=0.01), acoustic neuroma resection (5.5% versus 0.2%, P=0.03), MVD (20% versus 3%, P=0.02), and rotator cuff repair (23% versus 10%, P=0.01). CON status had no effect on proportion of cases occurring at teaching facilities. <\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p> CON laws appear to maintain patient access to elective surgical care while successfully reducing hospital charges. The location of surgery may shift to non-profit centers suggesting preferential certificate distribution, though this only partly explains the decreased charges in states with CON regulation. <\/jats:p><\/jats:sec>","DOI":"10.25011\/cim.v31i5.4869","type":"journal-article","created":{"date-parts":[[2017,5,2]],"date-time":"2017-05-02T23:26:13Z","timestamp":1493767573000},"page":"E236-E241","source":"Crossref","is-referenced-by-count":4,"title":["Impact of US state government regulation on patient access to elective surgical care"],"prefix":"10.3138","volume":"31","author":[{"given":"Elana C","family":"Fric-Shamji","sequence":"first","affiliation":[{"name":"Sanford Institute of Public Policy, Duke University 201 Science Drive, Durham, North Carolina, USA, 27708"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammed F","family":"Shamji","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, Duke University"},{"name":"The Ottawa Hospital, Department of Neurosurgery 1053 Carling Avenue, Ottawa, Ontario, Canada, K1Y 4E9"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1696","container-title":["Clinical and Investigative Medicine"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/cimonline.ca\/index.php\/cim\/article\/viewFile\/4869\/1737","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/utppublishing.com\/doi\/pdf\/10.25011\/cim.v31i5.4869","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,13]],"date-time":"2025-03-13T18:21:52Z","timestamp":1741890112000},"score":1,"resource":{"primary":{"URL":"https:\/\/utppublishing.com\/doi\/10.25011\/cim.v31i5.4869"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2008,10,1]]},"references-count":0,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2008,10,1]]}},"alternative-id":["10.25011\/cim.v31i5.4869"],"URL":"https:\/\/doi.org\/10.25011\/cim.v31i5.4869","relation":{},"ISSN":["1488-2353"],"issn-type":[{"type":"electronic","value":"1488-2353"}],"subject":[],"published":{"date-parts":[[2008,10,1]]}}}