Back to Annual Meeting

Back to Annual Meeting

APHA Scientific Session and Event Listing

Recorded presentation

Barbara Bridgman Perkins, PhD, Independent Scholar, 1806 24th Ave NW, Olympia, WA 98502, (360) 570 8786, bbridgperk@aol.com

This presentation first introduces the session as a whole by providing an overall view of the continuing need for system-wide medical care reform and raising some questions about attaining it. It then discusses the need for controlling the growth and distribution of costly medical specialty services and their technologies. Certificate of Need is the regulatory process established to serve this control function. In adding technology to the process forty-one years ago, New York State identified an already “explosive growth” in radiation therapy and open heart surgery services in “disproportion to the needs and resources of the community.” In some ways, Certificate of Need is the antithesis of market reform. Yet it too, incorporates market-oriented concepts and actions. Its concept is historically based in early twentieth-century concerns about the cost of capital and control over its investment in order to safeguard the “perpetuation of the investment” for the economy and maximize financial outcomes for the hospital. Whether institutions are public or private, non-profit or for-profit, regulatory processes evaluate them with similar financial values and requires similar economic behaviors. The expectation that each service support itself with patient care revenues, for example, shaped not only utilization, but service design itself. The presentation concludes by considering how business models have shaped the conceptualization of regional delivery systems. In both service and system development, dominance of economic criteria has led to the neglect of service efficacy and population need.

Learning Objectives: At the conclusion of this presentation, participants will be able to

• List systemic reform features in health care delivery,
• Enumerate economic criteria used in technology regulation,
• Identify how Certificate of Need both reinforces and challenges a business model of medical delivery.

Keywords: Health Care Delivery, Certificate of Need

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation