The Relationship Between Certificate of Need Laws and Mortality

Jonathan H. Cantor; Jill Horwitz; Christopher M. Whaley; Anthony Yu

doi:10.3386/w34403

The Relationship Between Certificate of Need Laws and Mortality

Jonathan H. Cantor, Jill Horwitz, Christopher M. Whaley & Anthony Yu

Working Paper 34403

DOI 10.3386/w34403

Issue Date October 2025

Certificate of Need (CON) laws regulate entry and capital investments in healthcare with the goal of containing costs while preserving access and quality. This paper examines the relationship between these laws and overall mortality as well as leading causes of mortality: cancer and cardiovascular disease. Using county-level death records, we conducted an event-study analysis comparing mortality rates in states that repealed their CON laws to states that did not between 1979 and 2004. The repeal of CON laws was associated with short-run reductions in cancer mortality, primarily from reductions in lung cancer mortality. Cardiovascular mortality and all-cause mortality rates were unchanged.

We thank Xiaoyu Yang, Jesse Bowman, and law librarians at UCLA and Northwestern University for excellent research assistance. We thank David Powell for generously providing his code and data to flag cancer deaths in the National Vital Statistics System. We thank Christine Eibner and Paul Koegel for providing important feedback. We also thank Mohan Ramanujan and Carla Tokman at the NBER for help accessing data. We thank the National Institute on Aging for supporting this research via grant R01AG073286 (PI: Whaley). The views in this paper represent the opinions of the authors and neither the NIH nor any institutions with which they are affiliated. The views expressed herein are those of the authors and do not necessarily reflect the views of the National Bureau of Economic Research.

Christopher M. Whaley
I have received grant funding from the National Institute on Aging (K01AG061274 and R01AG073286), the California Health Care Foundation, the Health Care Services Corporation, Patients Rights Advocates, the California Public Employees’ Retirement System, Arnold Ventures, the National Institute for Health Care Management Foundation, and the Robert Wood Johnson Foundation. I have received consulting payments unrelated to this study from Analysis Group, Doximity, Kong, Inc, the California Office of Health Care Affordability, and the Rhode Island Attorney General's office.
Copy Citation

Jonathan H. Cantor, Jill Horwitz, Christopher M. Whaley, and Anthony Yu, "The Relationship Between Certificate of Need Laws and Mortality," NBER Working Paper 34403 (2025), https://doi.org/10.3386/w34403.

The Relationship Between Certificate of Need Laws and Mortality

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