Date of Award


Document Type


Degree Name

Doctor of Health Administration


College of Health Professions

First Advisor

Kit N. Simpson

Second Advisor

Michael R. Meacham

Third Advisor

Ryan Blackledge


To help control rising healthcare costs, states implemented certificate of need (CON) programs to prevent unnecessary duplication of healthcare resources. Today, 37 states and the District of Colombia have some form of CON. The scope of CON oversight varies between states, but most states have some type of regulation for MRI scanners, whether it be a direct requirement applicable to all MRI scanner projects or an indirect requirement that may only impact some MRI scanner projects. The study analyzed retrospective commercial billing data for over 275,000 encounters to quantify differences in costs for MRI scans in each state according to the type of CON requirements for MRI scanners. When the data were aggregated only by type of CON requirement, directly regulated states had the lowest mean payment amounts (p-value <0.0001) followed by indirectly regulated states (p-value < 0.0001) with unregulated states having the highest mean payment amounts. When only state mean payment amounts were considered, the variance was not significant. Based on these results, CON programs may result in lower costs on a per-unit basis.


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