William J B, Walsh D C
N Engl J Med. 1975 May 15;292(20):1054-61. doi: 10.1056/NEJM197505152922004.
Massachusetts, like 22 other states, regulates its health-care industry in part through a certification and changes in service. As a basis for assessing the program's impact, data from the first 19 months are aggregated. A total of 209 determinations were made during the period, 21 involving beds in general hospitals, and 107 beds in long-term-care facilities. They apparently forestalled the addition of 478 beds in the general-hospital sector and of 1885 long term-care beds. Most of the 40 "facility-improvement" and 35 of 37 clinic proposals were approved. Fifteen determinations were appealed. Hindrances to assessment certification-of-need are formidable. As a consumer-oriented regulatory tool, it is valuable though limited since it can only react to proposals and can neither initiate nor provide positive incentives for new programs.
马萨诸塞州与其他22个州一样，部分通过认证和服务变更来规范其医疗行业。作为评估该计划影响的依据，收集了前19个月的数据。在此期间共做出了209项决定，其中21项涉及综合医院的床位，107项涉及长期护理机构的床位。这些决定显然阻止了综合医院部门新增478张床位以及长期护理机构新增1885张床位。40项“设施改善”提议中的大多数以及37项诊所提议中的35项获得了批准。有15项决定遭到了上诉。需求认证评估存在巨大障碍。作为一种以消费者为导向的监管工具，它虽然有价值但也有局限性，因为它只能对提议做出反应，既不能发起新项目，也不能为新项目提供积极激励。
