<<  <  >  >>

A related impact

ties, such as short-term general hospitals, spe-

sured due to failure to get timely and adequate

cialty psychiatric facilities (short-term and

diagnostic and treatment services.

of particular

long-term), and substance abuse treatment

Finally, social welfare costs arise whenever reg-

importance in

facilities (including detoxification facilities);

ulatory costs result in higher taxes and/or

health services

ambulatory care facilities, such as hospital out-

when compliance costs result in higher prices.

patient departments, medical offices/clinics,

This category includes the lost consumer and

regulation would

ambulatory surgical centers (ASCs), birthing

producer surpluses resulting from these taxes

be any morbidity

centers, diagnostic imaging centers (DICs),

and/or compliance costs (also called efficiency

outpatient laboratories, and pharmacies; and

or deadweight losses) as well as any compan-

or mortality

post-acute care facilities, such as home health

ion collection and compliance costs associated

losses that are the

and hospice services, renal dialysis centers,

with whatever method of taxation is used to

inadvertent result

skilled nursing facilities (SNFs), and interme-

finance government regulatory costs.

diate care facilities (ICFs, including those for

of regulations.

the mentally retarded).

Health Facilities Regulation

I have adopted a consistent style of pre-

senting results, starting first with the standard

distinction between access, cost, and quality.

There is an enormous variety of health

First, it is a bit more manageable to compare

facilities in the U.S. health system, all subject

and contrast the sheer number of regulations

to varying degrees of health services regula-

when sorted in this fashion. Second, and relat-

tion. Facilities include inpatient hospital facili-

Table 2

Cost of Health Facilities Regulation (millions of 2002 dollars)

Costs

Benefits

Type of Regulation

Expected

Minimum Maximum

Expected

Minimum

Maximum

Net Cost Percent

Access

11,764

2,192

29,676

3,805

701

8,236

7,959

31.7%

EMTALA

4,436

1,261

10,965

2,146

421

4,930

2,291

9.1%

Hospital uncompensated care pools

6,678

698

16,591

1,524

233

3,601

5,154

20.6%

Hospital community service requirements

317

123

961

135

46

397

182

0.7%

Hospital conversion regulations

9

8

132

-

-

-

9

0.0%

Limited English proficiency requirements

324

102

1,027

-

-

-

324

1.3%

Costs

14,128

11,949

190,378

14,840

20,745

27,095

(712)

-2.8%

Health care fraud and abuse

3,209

2,224

9,945

2,154

1,808

2,912

1,054

4.2%

Facility medical records (includes privacy)

1,068

696

9,217

1,222

993

1,450

(154)

-0.6%

Organ transplant regulation

1,815

1,653

1,785

1,807

280

4,644

8

0.0%

Certificate of need

110

26

157,859

-

5,067

-

110

0.4%

Hospital rate setting

69

57

3,023

51

4,421

-

18

0.1%

Pharmaceutical price regulation

7,626

7,163

8,149

9,606

8,176

18,088

(1,980)

-7.9%

Other cost-related facilities regulations

233

129

400

-

-

-

233

0.9%

Quality

21,799

9,596

57,592

3,973

3,973

3,973

17,827

71.1%

Hospital accreditation/licensure

8,640

833

31,885

-

-

-

8,640

34.5%

Nursing home accreditation/licensure

3,581

1,963

6,821

3,973

3,973

3,973

(392)

-1.6%

Other facilities accreditation/licensure

2,078

465

7,447

-

-

-

2,078

8.3%

Peer Review

2,063

1,314

5,481

-

-

-

2,063

8.2%

Clinical Laboratory Improvement Act (CLIA)

3,236

3,065

3,466

-

-

-

3,236

12.9%

Other quality-related facilities regulations

2,200

1,955

2,492

-

-

-

2,200

8.8%

Grand Total

47,692

23,737

277,645

22,617

25,418

39,303

25,074

100.0%

Note: Figures may not add up to totals due to rounding.

6