That stands in sharp contrast to
The lack of such a system is a key reason why
These CONs, as they're called, may sound wonky -- but they've been part of the American health care landscape for decades and aim to protect businesses as well as consumers.
"The basic assumption underlying CON regulation is that excess capacity stemming from overbuilding of health care facilities results in health care price inflation," said a review by
"Mandatory regulation through health planning agencies determined the most urgent health care needs, contributed to solutions for these needs and attempted to manage the fluctuations in prices often found in a competitive market. The intent was that new or improved facilities or equipment would be approved based primarily on a community's genuine need. Once need was established, the applicant organization was granted permission to begin a project."
As residents from
Malibu has 47 licensed centers, the same number as the entire state of
How did this hyper-concentration happen? Some trace it back to the 1980s, when
Some argue it hasn't worked out well in
"It's so bad right now I get three to four calls a month from people who tell me they want to open up a 'detox center' and can I help them," said
"Most are target-marketing young adults from out-of-state who are relying heavily on mommy and daddy's PPO insurance. But there's no showing of need. Show me that
"Telling me (that) there are 80,000 guys in
Keeping the lid on
Instructions run dozens of pages long and require applicants to address an exhaustive list of questions in what may be the healthcare equivalent of
Staffers at the
Among many other things, would-be providers must complete a "patient panel" with supporting data to demonstrate the need for the project, including disease burden, behavioral risk factors, health disparities and other objective measures. They must show that their projects will result in improved health care outcomes in
States with CON or CON-like laws governing substance abuse treatment centers include
"CON is usually implemented to control costs, supply, or both," Noble said.
"The evidence is not consistent on whether it controls cost," she added. "But it appears to work well if you're trying to control supply."
How the lid came off in
The CON concept has a long and tortured history in
The state's first CON program was enacted in 1969 and was required for the placement of acute general hospitals, skilled nursing facilities, acute psychiatric hospitals, intermediate care facilities, and for the conversion of existing hospital beds to a different type of service.
"For more than 30 years, state and local planning agencies were involved in analyzing and approving the construction and expansion of health care facilities and services, based on a determination of community need," said a 2006
From 1970 to 1973, about 14,000 additional beds for
But that rarely happened.
Several studies challenged the basic assumption inherent in CON laws; that restricting the supply of health care facilities reduces health care costs. In fact, they contended, it increased costs by restricting competition.
But CON supporters pointed to competing studies that found regulation exerts a downward pressure on spending and health care costs, compensating for imperfections in the market and promoting access to quality care, especially in rural areas.
Debate became largely moot after
A review during the same time period for several huge employers -- car makers
As a new anti-regulation mood sweeps the nation, more states are reconsidering CONs.
Some wonder if
"Of course we should have licensed treatment centers in proportion to the local need -- that's eminently logical," said
Her city has 35,000 citizens and 29 state-licensed facilities -- nearly as many as
"The local population does not need that many treatment centers," Girand said.
For one miserable year,
"This has legs for limiting the number of facilities," Szabo said of CONs. "Part of the problem we have in
"I think it's unfair to let homeowners dictate and decide where other people can get their health care needs met," said Scharff. "People say 'we don't want these facilities in our neighborhood,' so often, even if there's a need, you wouldn't get a certificate."
Predicating substance abuse treatment licensing on local demand ignores a basic reality, she said: If one is going to endure the extreme physical discomfort of trying to get clean, one would rather do it by the seashore.
"If you're given the choice between
"The treatment centers and the community really need to be on the same side," she said. "Every community has this problem of addiction. It's your children. Your parents. Your husbands and wives. We have to come to a consensus that says, 'what are we going to do to help these people?'"
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