Substance use Certificate-of-Need laws and treatment access
Publication id: shakya-2024-sud-certificate-of-need
Status: verified
Citation: Shakya, S., & Bretschneider Fries, C. (2024). The effect of substance use Certificate-of-Need laws on access to substance use disorder treatment facilities. Southern Economic Journal. Download PDF
Facts¶
Policy hook¶
Do Certificate-of-Need (CON) laws, which require healthcare providers to prove regulatory necessity before expanding services, help or harm access to substance use disorder treatment facilities? These laws aim to prevent wasteful spending but critics argue they create barriers to entry and reduce access to care.
Main finding¶
Counties in states with CON laws that border counties without CON laws have approximately 10 percent less spatial accessibility to substance use disorder treatment facilities. For services like buprenorphine and naltrexone, border counties with CON laws showed 6-11 percent lower access, while federally-certified opioid treatment programs showed 6 percent higher access.
Data and setting¶
2020 data from the National Directory of Drug and Alcohol Abuse Treatment Facilities, identifying 12,018 unique opioid-related treatment facilities across 3,143 counties. As of 2020, 23 U.S. states had CON laws for substance use treatment. Analysis used facility coordinates and measured driving distance and time from population-weighted county centroids.
Research design (plain language)¶
Spatial accessibility index based on driving distance and duration to nearest treatment facilities, accounting for travel impedance and facility capacity. Border comparison framework similar to difference-in-differences but replacing time dimension with border identifier, comparing border counties in CON states versus border counties in non-CON states to control for unobservable state-level factors. Applied inverse hyperbolic sine transformation to facilitate interpretation as percentage changes.
One caveat¶
The study measures spatial proximity to treatment facilities but does not account for the actual availability of specific services at those facilities or the capacity of facilities to serve patients. Limited to 2020 data, which may not reflect current conditions given that some states modified or repealed CON laws during the COVID-19 pandemic.
PDF or DOI¶
Why it matters¶
Geographic distance to treatment is critical for substance use disorder recovery success. People with substance use disorders often face additional barriers including financial and transportation constraints. CON laws were designed to prevent wasteful healthcare spending, but this evidence shows they reduce access to treatment precisely when the opioid crisis demands expanded treatment capacity. The study reveals unintended consequences of supply-side regulations on a population already facing significant obstacles to recovery. Understanding these regulatory effects is essential for policymakers addressing the opioid epidemic and ensuring treatment accessibility for those seeking help.