The causal effect of repealing Certificate‐of‐Need laws for ambulatory surgical centers: Does access to medical services increase?

In many states, Certificate‐of‐Need (CON) laws prevent ambulatory surgical centers (ASCs) from entering the market or expanding their services. This paper estimates the causal effects of state ASC‐CON law repeal on the accessibility of medical services statewide, as well as for rural areas. Our findings show that CON law repeals increase ASCs per capita by 44%–47% statewide and 92%–112% in rural areas. Repealing ASC‐CON laws causes a continuous increase in ASCs per capita, an effect which levels off 10 years after repeal. Contrary to the “cream‐skimming” hypothesis, we find no evidence that CON repeal is associated with hospital closures in rural areas. Rather, some regression models show that repeal is associated with fewer medical service reductions.