From: Certificate of need laws: a systematic review and cost-effectiveness analysis
Parameters: | DISTRIBUTION | @RISK FORMULA | EXPECTED | LOWER BOUND (5%) | UPPER BOUND (5%) | NOTES | Â | |
---|---|---|---|---|---|---|---|---|
Government Regulatory Costs | ||||||||
[P1] | Total states with CON, 2008 | Constant | 37 | 37 | 37 | 37 | [a] | Â |
[P2] | Average FTE CON employees in states with CON | Truncated Normal | 10.2 | 10.2 | 5.1 | 15.3 | [b] | Â |
[P3] | Annual total compensation, state employees, 2008 | Normal | 52,058 | 52,058 | 39,044 | 65,073 | [c] | Â |
Compliance Costs | ||||||||
[P4] | Average spending per CON application, WA, 2013 | Constant | 124,936 | 124,936 | 124,936 | 124,936 | [d] | Â |
[P5] | Average annual number of CON applications, WA | Constant | 52 | 52 | 52 | 52 | [e] | Â |
[P6] | Personal health care expenditures (PHCE), WA, 2008 (millions) | Constant | $ 42,411 | $ 42,411 | $ 42,411 | $ 42,411 | [f] | Â |
[P7] | Percentage change in PHCE, U.S., 2008–2013 | Constant | 17.9% | 17.9% | 17.9% | 17.9% | [g] |  |
[P8] | CON compliance spending per $10,000 PHCE | Normal | $ 1.29 | $ 1.29 | $ 0.97 | $ 1.61 | [h] | Â |
[P9] | Personal health care expenditures (PHCE), 2008 (000’s) | Normal | $ 1,997,199 | $ 1,997,199 | $ 1,964,445 | $ 2,029,953 | [i] |  |
[P10] | Share of PHCE in states with CON, 2008 | Constant | 56.6% | 56.6% | 56.6% | 56.6% | [j] | Â |
[P11] | PHCE spending in CON states, 2008 (millions) | Calculated | $ 1,130,663 | $ 1,130,663 | $ 1,112,100 | $ 1,149,200 | [k] | Â |
Key Impacts | ||||||||
Health expenditures | ||||||||
[P12] | Medicare expenditures, 2008 (millions) | Normal | $ 440,758 | 440,758 | $ 433,530 | $ 447,987 | [l] | Â |
[P13] | Share of Medicare spending in states with stringent CON, 2008 | Constant | 19.2% | 19.2% | 19.2% | 19.2% | [m] | Â |
[P14] | Reduction in Medicare/eligible spending due to CON | Normal | 1.8% | 1.8% | 0.5% | 3.2% | [n] | Â |
[P15] | All other PHCE spending in CON states, 2008 (millions) | Calculated | $ 1,045,988 | $ 1,045,988 | $ 1027,402 | $ 1,064,578 | [o] | Â |
[P16] | Increase in per capita health spending due to CON | Exponential | 0.19% | 0.14% | 0.01% | 0.58% | [p] | Â |
[P17] | New CABG programs averted per 1000 CABG patients | Normal | 0.97 | 0.97 | 0.75 | 1.19 | [q] | Â |
[P18] | Capital cost per CABG program (millions) | Normal | $ 20.5 | $ 20.5 | $ 17.8 | $ 23.2 | [r] | Â |
[P19] | Amortized annual capital cost per CABG program (millions) | Normal | $ 2.0 | $ 2.0 | $ 1.7 | $ 2.2 | [s] | Â |
Patient time losses | ||||||||
[P20] | Time losses per CABG patient due to restricted supply | Normal | $ 7.50 | $ 7.50 | $ 3.75 | $ 11.25 | [t] | Â |
[P21] | Total CABGs in states with CON, 2008 | Normal | 238,586 | 238,586 | 131,404 | 267,020 | [u] | Â |
General elderly hospital mortality | ||||||||
[P22] | Elderly hospital patients, 2008 (thousands) | Normal | 13,902 | 13,902 | 11,504 | 16,300 | [v] | Â |
[P23] | Elderly in-hospital mortality risk, 2008 | Normal | 4.1% | 4.1% | 4.0% | 4.2% | [w] | Â |
[P24] | Increase in Medicare mortality rates due to stringent CON | Exponential | 0.3% | 7.9% | 6.1% | 9.7% | [x] | Â |
[P25] | VOSL, elderly, 2008 (millions of dollars) | Triangle | $ 2.9 | $ 2.9 | $ 0.6 | $ 5.9 | [y] | Â |
CABG mortality, all patients | ||||||||
[P26] | Change in CABG mortality rate/1000 patients due to CON | Calculated | −1.1 | −1.1 | −2.8 | 0.6 | [z] |  |
[P27] | Added life expectancy per CABG patient | Normal | 8.0 | 8.0 | 6.0 | 10.0 | [aa] | Â |
[P28] | Quality of life, CABG patients after 10 years | Normal | 0.9 | 0.9 | 0.7 | 1.1 | [ab] |  |
[P29] | Value of a quality-adjusted life year (QALY), 2008 (thousands) | Triangle | $ 239.1 | $ 239.1 | $ 120.7 | $ 407.0 | [ac] | Â |
CABG mortality, Medicare patients, stringent CON states | ||||||||
[P30] | Elderly CABGs in states with stringent CON, 2008 | Normal | 43,840 | 43,840 | 24,145 | 49,065 | [ad] | Â |
[P31] | Change in elderly CABG mortality rate/1000 due to stringent CON | Calculated | −7.3 | −7.3 | −14.76 | 0.13 | [ae] |  |
[P32] | Ratio of elderly CABG life expectancy to average CABG LE | Constant | 0.54 | 0.54 | 0.54 | 0.54 | [af] | Â |
CABG mortality rates, Medicare patients non-stringent CON states | ||||||||
[P33] | Elderly CABGs in states with CON, 2008 | Normal | 91,540 | 91,540 | 50,417 | 102,450 | [ag] | Â |
[P34] | Change in elderly CABG mortality rate/1000 in all CON states | Calculated | −0.9 | −0.9 | −2.0 | 0.1 | [ah] |  |
[P35] | Change in elderly CABG mortality rate/1000, non-stringent CON | Calculated | 4.9 | 4.9 | −5.8 | 32.9 | [ai] |  |
Social Welfare Losses | ||||||||
[P36] | Marginal tax overhead costs, federal taxes | Normal | 48.2% | 48.2% | 38.1% | 64.3% | [aj] | Â |
[P37] | Marginal tax overhead costs, state taxes | Normal | 40.5% | 48.2% | 32.4% | 53.9% | [ak] | Â |
[P38] | Marginal excess burden, sales taxes | Normal | 23.3% | 48.2% | 20.4% | 26.1% | [al] | Â |