Healthcare Paper on Certificate of Need in Oregon, Wisconsin, and Minnesota

The Certificate of Need (CON) is a national law that was related to the Hill-Burton Act in 1946. The main aim of establishing the Certificate of Need programs was to ensure that there is regulation of the number of beds that a hospital or a nursing home can have. Through the CON, hospitals and nursing homes could be prevented from purchasing more equipment than the required. Mandatory regulation spearheaded by various health planning agencies established the most urgent health care needs and provided feasible solutions to the existing requirements. The agencies also managed price fluctuations which are common in a competitive market. A CON statute was first developed in New York in the year 1964. By the year 1974, this federal act made it a requirement for all the 50 states to have a proposal for the Certificate of Need.

Pros to the CON

            Through the Certificate of Need, healthcare spending is regulated, and hence there are possibilities of creating new medical centers mainly in the rural areas which have been ignored in the past. The program also includes opinions from the public and stakeholders thus improving service delivery in medical facilities. The Healthcare systems have for a long time been viewed as an economic product; the CON seeks to eliminate this trend. The CON program also doesn’t categorically block change but instead calls for thorough scrutiny and assessment which is essential in service delivery.

Cons to CON

            The price of care can be high because the CON is likely to reduce the cost of competition between different facilities. Expert opinions of Healthcare Institutions suggest that health should be left to the economics of each healthcare institution because the influence of politics can end up creating selfish interests (Meesa, Meeker & Mukherji,  2014). The community does not have a clear interest or a definite point of view to the CON; hence its implementation may be taken negatively by the community. Furthermore, decisions made for the benefit of the community may end up having unintended consequences in states with the unsteady economy. The CON programs which vary from one state to another also leads to inconsistent metrics and variable type of management systems.



Certificate of Need Requirements

Oregon Wisconsin Minnesota
·         It is a requirement for health care providers to acquire permission at the state level before any significant capital investments.

·         CON was effected from the year 1971 and is up to date.

·         Oregon health is the Licensing Agency, and the Authority is Public Health Division

·         All the facilities are regulated as provided by the Certificate of Need law.

·         Hospitals are classified as under long term care facilities or specialty inpatient care.

·         There are no moratoria


·         There are variations in the CON.

·         Wisconsin Department of Health Services is responsible for the licensing and acts as a Certification Agency.

·         The state doesn’t have a Certificate of Need.

·         The relevant statutes do not recognize the term “Certificate of Need.” Nevertheless, the state upholds the approval process for any nursing home.

·         This state maintains a Certificate of Public Advantage Program used for cooperative provider agreements (Hyman & Crane, 2017).

·         There are no moratoria in this state.

·         Although Minnesota has CON, there is no formal CON program from 1971 to 1984

·         Minnesota Department of Health is responsible for the licensing and acts as a Certification Agency.

·         There are several approval processes retained by the state that function similarly to CON: There is a need for planning in the public health interest review and local systems.

·         The state has moratoria.

·         The moratoria cover hospitals and expansion of beds, radiation therapy facilities and nursing homes.


Summary of the Findings

Basing on comparative analysis that is extracted from the table above, it can be concluded that Wisconsin has the least onerous law because, at the moment, it is not enforcing the Certificate of Need law. Furthermore, in Wisconsin state, the CON approval is only needed for nursing homes thus making it a least onerous law state. The phrase “Certificate of Need” is also not recognized in relevant statutes.

Minnesota state is the most difficult given by the fact that there is a high level of scrutiny and legal burden that any new establishments will be subjected. Additionally, the state requires an extensive and expensive break down of all the necessities and also gives alternative solutions to prove the case thus making the state to be the most difficult (Rothenberg, 2016). Minnesota State also has several approval processes which make it very difficult because of the detailed information required at each stage of approval.

The Certificate of Need laws can be termed to be controversial given that there are different regulations and rules in each state which can be used to obtain the same needs if the healthcare system is to be equal and fair, then the processes from one state to another should be identical. The Certificate of Need law can be amended so that it is applied without discrimination across the fifty states and this can be achieved through proper research and review of the existing systems.


Figure 1.

Source: American Health Planning Association. Copyright 2018


Hyman, H. H., & Crane, R. M. (2017). Health regulation: Certificate of need and 1122.                             Germantown, Md: Aspen Systems Corp.

Meesa, I. R., Meeker, R. A., & Mukherji, S. K. (January 01, 2014). Certificate of need                  . Neuroimaging Clinics of North America, 22, 3, 443-50.

Rothenberg, E. (2016). Regulation and expansion of health facilities: The certificate of need                       experience in New York State. New York: Praeger.