Innovative uses of CON as a mechanism for public accountability to make health care delivery function “as a system” at the community level

This presentation will review case studies of CON and appropriateness reviews to highlight how changes in the health care delivery system can be evaluated (and shaped) from a public health perspective taking into account: (1) community needs assessment and prioritization processes; (2) coordination of health care resources within the community; (3) intervention strategies for addressing social determinants of health; and (4) strategies for reducing health disparities. Certificate of need (CON) review processes developed out of community health planning (CHP) activities in the 1960's in Rochester, NY to improve health care delivery, avoid over-building the health care system, and provide community input into prioritizing health care needs at the community level. Health System Agencies (HSAs) were promoted by the Community Health Partnership Act of 1966 and funded around the country through the National Health Planning and Resources Development Act of 1974. Although defunded at the federal level under Reagan in the mid-1980s, many states continue to operate some form of CON in limited ways, while relying on market forces to shape the health care delivery system. With health care reform seeking ways to increase efficiency, contain costs, and improve quality, it is revealing that CHP and CON were largely omitted from the health care reform legislation at the federal level, and that medical care and social determinants of health are largely treated separately in the fragmented health care marketplace, in state Departments of Health, and even in APHA activities.