Certificate of Need
Healthcare Isn’t a Free Market – And It Can’t Be
Healthcare is a non-negotiable need for everyone. Patients can receive care any time at a hospital, regardless of their ability to pay. These realities mean healthcare does operate as a true free market – it can’t be, nor should we treat it like it is. Ensuring care is available where people live, not where it's most profitable, is essential for access. Certificate of Need (CON) programs help us do that by protecting North Carolinians fromunchecked expansion that inflates costs, concentrates care in wealthy areas, and worsens workforce shortages.
THE FACTS
North Carolina’s net price for inpatient discharges is ~$1,000 less than the median for states without CON programs (Ascendient).
Hospital bed distribution is more balanced across all sizes of communities compared to states without CON (Ascendient).
Equitable Access Doesn't Happen by Accident
CON programs use data-driven planning to guide where healthcare services are added or expanded, aligning infrastructure with community need.
In practice, CON helps:
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Sustain access for rural communities and medically underserved populations.
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Prevent unnecessary duplication of services and manage system-wide costs.
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Protect hospitals’ ability to offer essential, but unprofitable services. Other states offer a cautionary tale. After Texas repealed its CON program, rural acute care hospital closures spiked – increasing from three hospital closures in 1985 to 11 closures in 1987 and 12 closures in 1989 – as services consolidated in more profitable markets. When planning disappears, access follows profit, and communities pay the price (Texas Organization of Rural & Community Hospitals).
WHY IT MATTERS
North Carolinians depend on hospitals and providers being there when they need care – regardless of their income, insurance coverage, or zip code.
Without CON safeguards, market pressures can make it difficult to sustain essential healthcare services where they're needed most. That could mean:
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Hospitals close or cut services, forcing patients to travel farther for emergency care, maternity services, and mental health treatment.
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Services cluster in wealthier areas while rural and underserved communities lose access.
Reform Should Follow Facts
North Carolina has not yet fully implemented the CON reforms under the 2023 Access to Healthcare Options Act (SL 2023-7), which were passed alongside Medicaid expansion.
Before considering further changes, evaluating the real-world impact of the latest reforms is essential.
Rushing further modifications – or pursuing outright repeal – without evidence risks destabilizing the state’s healthcare system and jeopardizing access for rural and underserved communities at risk.
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Let’s Heal the System, Together.
Policymakers, community leaders, and engaged citizens: Join us in the fight to heal North Carolina’s healthcare system.
Stop financial harm to hospitals and providers. Hold insurance companies accountable. Protect care for every community.