Certification-of-need: The Massachusetts experience.

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.