Health Care Certificate-of-Need Laws: Policy or Politics?

NIHCR Research Brief No. 4
May 2011
Tracy Yee, Lucy B. Stark, Amelia M. Bond, Emily Carrier

Originally intended to ensure access to care, maintain or improve quality, and control capital expenditures on health care services and facilities, the certificate-of-need (CON) process has evolved into an arena where providers often battle for service-line dominance and market share, according to a new qualitative research study from the Center for Studying Health System Change (HSC). Interviews with respondents from six states with CON laws—Connecticut, Georgia, Illinois, Michigan, South Carolina and Washington—show stakeholder views vary widely about the effectiveness of CON regulations on access, quality and costs. In five of the six states studied—all except Michigan—the CON approval process can be highly subjective and tends to be influenced heavily by political relationships rather than policy objectives. While CON regulations and their administration are by all accounts imperfect, most respondents believe that CON programs should remain in place in their state and would benefit from increased funding for evaluation, improved compliance monitoring and movement toward a process driven more by data and planning rather than political influence.

This Research Brief can be accessed at the National Institute for Health Care Reform Web site.