Technology regulation reconsidered: The effects of certificate of need policies on the quantity and quality of diagnostic imaging

Jill R Horwitz; Austin Nichols; Anthony Yu; Carrie H Colla; David M Cutler

doi:10.1016/j.jhealeco.2025.103020

Technology regulation reconsidered: The effects of certificate of need policies on the quantity and quality of diagnostic imaging

J Health Econ. 2025 Jun 7:102:103020. doi: 10.1016/j.jhealeco.2025.103020. Online ahead of print.

Authors

Jill R Horwitz¹, Austin Nichols², Anthony Yu³, Carrie H Colla⁴, David M Cutler⁵

Affiliations

¹ Pritzker School of Law and Feinberg School of Medicine, Northwestern University; and NBER, United States.
² Amazon, Inc, United States.
³ RAND, United States.
⁴ Geisel School of Medicine, Dartmouth College, United States.
⁵ Department of Economics, Harvard University; and NBER, United States. Electronic address: dcutler@fas.harvard.edu.

PMID: 40543423
DOI: 10.1016/j.jhealeco.2025.103020

Abstract

Estimates of the impact of Certificate of Need (CON) laws on medical care have been inconsistent, possibly because not all CON laws apply to all services. Using an original dataset identifying imaging-related CON laws and a regression discontinuity design at state borders, we estimate the effects of CON on the use and quality of diagnostic imaging. Medicare beneficiaries in regulated states are less likely to receive any image and even less likely to receive low-value imaging than beneficiaries in unregulated states. High-value imaging is unaffected. Overall, CON for imaging reduces low-value care and leaves high-value care unchanged.

Keywords: Certificate of need; High value; Imaging; Low value.