In states with Certificate of Need (CON) laws, medical services providers must file an application and demonstrate community need before being permitted to start or expand a service. We examine CON laws for magnetic resonance imaging (MRI), computed tomography (CT), and positron emission tomography (PET) scanners to test the hypothesis that the approval process favors established incumbent hospitals over new hospital entrants and nonhospital providers. Using Medicare claims data in 2013, we find that states with CON laws have 20 to 33% fewer providers, depending on the type of scanners to which the laws apply. As a result, residents of CON law states are 3.4–5.3 percentage points more likely to travel outside their home county to obtain imaging services than residents of non-CON states. In addition, there is a notable shift in the type of provider: CON laws are associated with 27–53% fewer scans by nonhospital providers per beneficiary, 23 to 70% fewer by new hospitals, but 6 to 21% more scans in older hospitals.

在有需要证明书 (CON) 法律的州，医疗服务提供者必须提交申请并证明社区需要，然后才能开始或扩展服务。我们检查了磁共振成像 (MRI)、计算机断层扫描 (CT) 和正电子发射断层扫描 (PET) 扫描仪的 CON 法律，以检验批准过程有利于已建立的现有医院而不是新入院者和非医院提供者的假设。使用 2013 年的医疗保险索赔数据，我们发现有 CON 法律的州的提供者减少了 20% 到 33%，具体取决于法律适用的扫描仪类型。因此，与非 CON 州的居民相比，有 CON 州的居民前往家乡以外获得影像服务的可能性要高 3.4-5.3 个百分点。此外，提供者的类型也发生了显着变化：