State certificate-of-need programs: The current status

Abstract

Whether or not federal funding continues, it appears that a substantial number of states will retain certificate-of-need programs since CON regulation continues to satisfy a wide range of state policy roles. However, it also appears that several states may abandon the program in the absence of federal requirements to retain it, in favor of efforts to promote more competitive health service markets. This might well be a fortuitous development. Like any regulatory program that intervenes in the market to accomplish some social good, the need for CON programs ought to be continuously evaluated, and the scope of the program tailored to meet specific, concrete, and current purposes. This is difficult to do when all states adopt a nationally mandated program. The repeal of the program in some jurisdictions would offer a natural experiment to measure the impact of the presence or absence of certificate-of-need on the direction and scope of health facility expenditures.