Cross Border Effects of State Health Technology Regulation

Jill R. Horwitz, Daniel Polsky

NBER Working Paper No. 19801
Issued in January 2014
NBER Program(s):   HC   HE   LE

Certificate of Need Laws (CON), state laws requiring providers to obtain licenses before adopting healthcare technology, have been controversial. The effect of CON on technology supply has not been well established. In part this is because analyses have focused on state-level supply effects, which may reflect either the consequence of CON regulation on supply or the cause for its adoption or retention. Instead, we focus on the cross-border effects of CON. We compare the number and location of magnetic resonance imaging providers in counties that border states with a different regulatory regime to: 1) counties in the interior of states, 2) counties on state borders with the same regulatory regime on both sides, and 3) counties on borders with different regulatory regimes, but with a large river on the border. We find there are 6.4 fewer MRIs per million people in regulated counties that border counties in unregulated states than in unregulated counties that border regulated counties. This statistically significant finding that regulatory spillover can be sizable should be accounted for in future research on state-based health technology regulation. In addition, it suggests state experiences may not accurately predict the effects of CON if it were implemented nationally.

download in pdf format
   (460 K)

email paper

The NBER Bulletin on Aging and Health provides summaries of publications like this.  You can sign up to receive the NBER Bulletin on Aging and Health by email.

Supplementary materials for this paper:

This paper was revised on November 20, 2014

Machine-readable bibliographic record - MARC, RIS, BibTeX

Document Object Identifier (DOI): 10.3386/w19801

Published: Jill R. Horwitz & Daniel Polsky, 2015. "Cross Border Effects of State Health Technology Regulation," American Journal of Health Economics, vol 1(1), pages 101-123.

Users who downloaded this paper also downloaded these:
Gaynor, Ho, and Town w19800 The Industrial Organization of Health Care Markets
Frakes and Jena w19841 Does Medical Malpractice Law Improve Health Care Quality?
Li and Dor w18926 How Do Hospitals Respond to Market Entry? Evidence from A Deregulated Market for Cardiac Revascularization
Gadenne and Singhal w19402 Decentralization in Developing Economies
Dafny, Gruber, and Ody w20140 More Insurers Lower Premiums: Evidence from Initial Pricing in the Health Insurance Marketplaces
NBER Videos

National Bureau of Economic Research, 1050 Massachusetts Ave., Cambridge, MA 02138; 617-868-3900; email:

Contact Us