Frances Leslie Lucas and Andrea Siewers, both of the Center for Outcomes Research and Evaluation at the Maine Medical Center in Portland, Maine, and colleagues say the certificate-of-need process, required an applicant to demonstrate need and capacity to provide high-cost new medical services. However, when the federal government repealed its certificate-of-need mandate, many states did too.
As a result, from 1993 to 2004, 276 cardiac surgery programs opened in general hospitals and 25 opened in specialty hospitals, mostly in the East and Midwest. Theoretically, creating the program should increase access for bypass and related heart surgery.
The study, published in the journal Health Affairs, found the median travel time for Medicare beneficiaries declined from 17 minutes in 1993 to 14 minutes in 2004, but for residents of rural areas, the travel time decreased by about 10 minutes. However, overall travel time changed little and the new programs led to a fight for shares of a shrinking market, the researchers say.
"Despite potential benefits for some patients, particularly those living in rural areas, we found substantial evidence of duplication of services in highly competitive markets, as well as the proliferation of specialty cardiac hospitals, without improvements in geographic access for the vast majority of patients," the study authors say in a statement. "Flawed though it may be, the certificate-of-need process is one way to avoid spending money to needlessly duplicate a service that already exists, in some cases within the same ZIP code."
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