Research & Commentary: Pennsylvania Should Not Backslide on Certificate of Need

Published June 10, 2015

Pennsylvania is one of 14 states that do not require hospitals to acquire a certificate of need (CON) to introduce new medical services or facilities. Pennsylvania’s CON statute expired in 1996. Proponents of these laws say certificate of need (CON) laws help slow the growth of health care prices, promote consolidation of health care providers, and limit duplication of services. Many states require CON commission approval for a wide range of expenditures, including the construction of new hospitals, purchase of major pieces of medical technology, or offering new medical procedures. 

No other state without a certificate of need law is currently considering a bill to impose such regulation, and at least a half-dozen states are considering rolling back parts or all of their CON laws, to reduce health care costs and increase competition. Scientific studies show CON laws fail to achieve many of their stated goals and in fact increase costs for consumers by hindering competition and forcing providers to use older facilities and equipment. A study published by the Mercatus Center at George Mason University assembled a comprehensive database on CON regulations and found CON laws raise the cost and undermine the quality of health care. 

The authors found CON laws raise the price of medical care by preventing new medical providers from competing with existing hospitals. CON laws also reduce the availability of medical equipment and hospital beds; states with CON laws had 99 fewer hospital beds per 100,000 residents and lower availability of MRI services, CT scanners, and optical and virtual colonoscopies. They conclude more evidence of benefits of CON laws is needed before the government is justified in restricting competition among health care providers. 

Data from the Kaiser Family Foundation show health care costs are 11 percent higher in CON states than in non-CON states. The study also found a positive correlation between the number of CON law restrictions and the cost of health care. States requiring certificates of need on 10 or more services averaged per capita health care costs 8 percent higher than the $6,837 average for states requiring certificates of need for fewer than 10 services. 

CON laws give inappropriate influence to competitors during vetting processes. When a company applies to enter a new market, competitors often use the CON process to block potential competition. As a result, CON laws raise the cost of medical care by preventing new medical providers from competing with existing hospitals.

The primary goal of CON programs is to slow the rise of health care costs, yet research shows they actually increase costs for consumers by hindering competition and reducing incentives for providers to use newer facilities and equipment. These are burdensome regulations that increase the cost of health care while limiting access and benefitting those with political connections. Pennsylvania lawmakers should not revive a failed policy the state wisely abandoned decades ago. 

The following documents provide additional information about certificate-of-need laws. 

Do Certificate-of-Need Laws Increase Indigent Care?  
Thomas Stratmann and Jacob Russ of the Mercatus Center at George Mason University examine certificate of need laws and their effects on prices and health care access. “While certificate of need laws significantly reduce available health care services for everyone, they do not lead to an increase in care for the needy,” Stratmann and Russ write.

Three Prescriptions for States to Improve Health Care
Matthew Mitchell, Anna Mills, and Dana Williams of the Mercatus Center at George Mason University discuss three ways states can benefit patients by making their health care markets more competitive: abolish certificate-of-need laws, liberalize scope-of-practice regulations, and remove barriers to telemedicine. 

The Great Healthcare CON
Jordan Bruneau of the Foundation for Economic Education says CON laws powerfully distort the health care market. He advises, “Rather than pinning our hopes on grand plans to overhaul the system, we should first look at where we can make changes on the margin that would move us in the right direction. Abolishing CON laws—a barrier to entry that drives up prices, restricts access, and is maintained by cronyism—would be a great place to start.” 

Certificate of Need: State Health Laws and Programs
The National Conference of State Legislatures outlines various state CON laws and the positions of CON law proponents and critics. 

Ten Principles of Health Care Policy 
This pamphlet in The Heartland Institute’s Legislative Principles series describes the proper role of government in financing and delivering health care and provides reform suggestions to remedy current health care policy problems. 

CON Job: State “Certificate of Necessity” Laws Protect Firms, Not Consumers 
Writing in Regulation magazine, Timothy Sandefur of the Pacific Legal Foundation argues certificate-of-need laws are not intended to protect the public but instead are designed to restrict competition and boost prices existing companies can charge. 

You Shouldn’t Have to Ask Your Competitors for Permission to Start a Business
Ilya Shapiro of the Cato Institute argues CON laws make it more difficult and expensive for companies to create new jobs and innovate. Even more troubling, Shapiro says, is the use of CON laws by existing businesses to bar newcomers from competing against them. 

Certified: The Need to Repeal CON: Counter to Their Intent, Certificate-of-Need Laws Raise Health Care Costs 
Jon Sanders of the John Locke Foundation says CON laws fail to lower health care costs and in many instances actually increase costs. Sanders says state leaders could best honor the intent behind CON programs—preventing unnecessary increases in health care costs—by repealing those laws. 

The Failure of Government Central Planning: Washington’s Medical Certificate of Need Program
John Barnes of the Washington Policy Center describes the history of the certificate of need concept, summarizes how the Washington State CON law works, compares its stated goals with actual performance, and offers practical policy recommendations for improving access to affordable health care for the people of Washington. 

Certificate-of-Need Laws: It’s Time for Repeal
Roy Cordato of the John Locke Foundation (JLF) examines certificate of need regulations in the first of a series of annual research papers from JLF devoted to explaining the principles of free markets and applying them to current controversies in North Carolina. 

Certificates of Need: A Bad Idea Whose Time Has Passed
In a policy analysis from the James Madison Institute, Peter Doherty argues federal marketplace interventions have proven disastrous and the government’s increased spending on such programs has not been a boon. Doherty wrote, “In the past 20 years, many of us have battled to moderate or eliminate the most egregious of these programs and the artificial controls they place on free markets, but despite our successes, vestiges of the past remain.” 

Health Care in the States
Michael Tanner of the Cato Institute compares health care reform among the states. Without a universal model to follow, states are creating their own reforms. Tanner examines how cost-effectiveness, insurability, and affordability vary between states.

Nothing in this Research & Commentary is intended to influence the passage of legislation, and it does not necessarily represent the views of The Heartland Institute. For further information on this subject, visit Health Care News at, The Heartland Institute’s website at, and PolicyBot, Heartland’s free online research database at 

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