Regulating Health Facilities Construction

Abstract

on Legal Issues in Health of Duke Uni- versity School of Law sponsored a conference on the rationales and problems of regulating construction of health facilities.The papers and discussions are presented under four general headings: (1) the basic arguments under- lying health planning in general; (2) an analysis of the certificate-of-need laws as the current manifestation of health facilities planning; (3) the problems of not-for-profit monopolies that are created or augmented by certificate-of- need laws; and (4) speculation on the future of such laws and of health planning in general.The bringing together of 34 lawyers, economists, bureau- crats, health planners, and health administrators to discuss a controversial and basic question such as planning is virtually certain to result in a variety of interesting analyses and debates.Some of the latter seem to have produced as much heat as light; one wonders if the editor has not mercifully censored a few of the spicier exchanges.In any case, the conference was successful in focusing attention on the basic issues of the need for and impact of health planning and in forcing representatives of all sides of the issues to make explicit the bases for their advocacy or opposition.Symond Gottlieb's discussion of the history of health planning in the United States is followed by a brief discussion by Robert Grosse of the need for health planning.Although these papers and the ensuing discussions touch on many aspects of the provision of health care, recognition of the market failure that has resulted from the institutional and technological peculiarities of the health industry appears to be the main impetus for further efforts in health planning.While there was some agreement that the health industry is in fact atypical, there was sharp debate as to whether health planning is the most effective way to deal with the industry's obvious problems.It is amazing that a question as central as that of the effectiveness of planning has received so little empirical investigation.Joel May finds only four such studies, in- FaIl 1976