Certificate of need

A certificate of need (CON), in the United States, is a legal document required in many states and some federal jurisdictions before proposed creations, acquisitions, or expansions of healthcare facilities are allowed. CONs are issued by a federal or state regulatory agency with authority over an area to affirm that the plan is required to fulfill the needs of a community.

CONs have been criticized for granting monopoly privileges to existing hospitals and healthcare facilities, thereby driving down the number of hospitals and hospital beds in a community. One study found that CON laws resulted in 50% fewer hospitals per 100,000 persons, and 12% fewer beds at the typical hospital. CONs have been blamed for the shortage of hospital beds during the COVID-19 pandemic in the United States.