The Competitor's Veto: What Eight Years of Kentucky Certificate of Need Decisions Reveal
- Question
- Does objection from existing providers predict whether a new health facility is permitted to enter a Kentucky market?
- Data
- 491 Certificate of Need applications, assembled by merging two administrative sources on facility name and application year, then coding service type, opposition status, review track, decision timeline, and capital expenditure for each case.
- Method
- Logistic regression on a binary approval outcome, with competitor opposition and referral to substantive review as the primary predictors. McFadden pseudo-R² = 0.211.
- Finding
- Against a baseline approval rate near 95 percent, competitor opposition is associated with roughly an 87 percent reduction in the odds of approval, and substantive review with a 74 percent reduction. Both p < 0.001.
- Limits
- Opposition is not randomly assigned. Incumbents plausibly object to the applications they judge most threatening, so the estimate reflects both the effect of opposition and whatever incumbents observe when deciding to object. Withdrawn applications sit outside the merits rate, which makes the reported approval figure an upper bound.