Certificate of need laws vary widely by stae

The certificate-of-need (CON) process required to open a new medical facility has evolved into an arena where providers compete for service-line dominance and market share, according to a new study conducted by the Center for Studying Health System Change for the National Institute for Health Care Reform.

CON laws remain in 36 states and the District of Columbia, according to the study, which focused on CON requirements in six states-Connecticut, Georgia, Illinois, Michigan, South Carolina, and Washington. 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, such as a provider's clout, organizational size, or overall wealth and resources, rather than policy objectives, according to respondents in the six states.