Graduation Year


Document Type




Degree Granting Department

Business Administration

Major Professor

Gabriel A. Picone, Ph.D.


Access, Quality, Excess demand, Reimbursement, Medicaid


The primary goals of the National Health Planning and Resources Development Act (P.L. 93-641) of 1974 were to (1) contain health care costs and (2) increase the accessibility and quality of health services. Certificate of need (CON) regulation is one attempt to constrain health care costs by limiting the supply of certain medical care facilities. With respect to the nursing home industry, prospective nursing home owners/operators are required to demonstrate that a "need" exists for more nursing home beds. Some States also imposed a construction moratorium that prevented any expansion of existing facilities or construction of new facilities regardless of whether or not a "need" existed. These CON/moratorium programs impose a supply side constraint that creates a potential barrier to entry and in the presence of excess demand may cause a nursing home bed shortage for those residents covered by Medicaid. Even though the Federal CON requirement lapsed in 1986, forty-two St

ates and the District of Columbia continue to have a CON, a construction moratorium, or both for nursing home facilities. Yet maintaining these regulations comes with a cost.This paper investigates if differences exist in the quality of care and the access to care between nursing homes in those States without CON and/or construction moratorium and those States that still have such policies. Using data for the years 1991 through 2003 for all freestanding Medicaid-/Medicare-certified nursing home facilities in the United States and employing state and facility fixed effects models we find that Medicaid-eligible residents in those states without CON and/or construction moratorium policies have more access to a nursing home bed than those individuals in states with these policies. With respect to quality of care the results are mixed depending on the measure of quality that is employed. With the risk of becoming a nursing home resident at the age of 65 at 44 percent and at the age of 8

5 at 53 percent (Spillman and Lubitz 2002) coupled with the aging of the current population, the areas of quality of care and access to care remain important policy issues in the nursing home industry.