Health services policymakers have used certificate of need(CON) regulation to help shape the health care system for more than three decades. The rationale for imposing market entry controls is that regulation, grounded in community-based planning, will result in more appropriate allocation and distribution of health care resources and, thereby, help assure access to care, maintain or improve quality, and help control health care capital spending.

A number of states established CON programs in the decade between 1964 and 1973. Following the passage of the National Health Planning and Resources Development Act (PL 93-641) in 1974, which effectively mandated state CON programs nationwide, nearly all states instituted planning controls by the late 1970s. The federal requirement that states maintain CON programs was lifted in 1986. Subsequently, fourteen (14 states) have eliminated their programs. Thirty-six (36) states and the District of Columbia now maintain CONprograms. The scope and focus of these programs vary considerably.

States maintain CON programs to achieve a number of health policy goals. These goals differ somewhat from state to state, and from one health service to another, but all CON regulation and related planning are intended to compensate for observed or predictable health care market deficiencies. Historically, the overriding consideration has been to promote access, ensure quality, and help control costs by limiting market entry to those facilities and services that are found to be needed, appropriately sponsored, and designed to promote quality and equitable access to care. Each state CON program implicitly incorporates these principles by predicating certification of regulated services on the basis of community or public need.