CONtroversy in Health Care: A Hard Look at North Carolina's Certificate of Need Laws

May 20, 2019

As health care costs continue to rise in the United States, patients are frequently exposed to unaffordable and unpredictable medical bills. In North Carolina, diagnostic imaging services such as MRI scans can cost patients more than a month’s income. In response to this, physicians like Dr. Singh of Winston-Salem, North Carolina, have attempted to part ways with major hospitals in order to offer quality medical procedures at lower, transparent prices. In states like North Carolina, however, Certificate of Need (“CON”) requirements prevent them from doing so by denying entities the ability to purchase major medical equipment or to open new facilities. Although CON programs were intended to lower health care spending when first implemented in the 1970s, the federal government has long-since declared these laws ineffective and even detrimental to health care spending and health care quality in the United States. However, CON programs have remained in effect in many states due to powerful lobbying and legislative resistance to reform. State CON programs, no matter the goals behind them, function to insulate incumbent providers from competition and allow those providers to set prices for services at arbitrarily high rates. In 2018, Dr. Singh filed a law suit against the North Carolina Department of Health and Human Services alleging that North Carolina’s CON statute violates his personal rights to economic substantive due process and equal protection under the North Carolina Constitution, as well as the state’s constitutional prohibition on monopolies and exclusive emoluments. North Carolina’s judicial branch has the opportunity to decide this case based on the traditional deference given to the state when applying the rational basis test, or by looking at the evidence presented and perhaps concluding that it does not support a finding of rationality.

  • Author: Suzanne Zelenka
  • Cite: Suzanne Zelenka, CONtroversy in Health Care: A Hard Look at North Carolina’s Certificate of Need Laws, 20 N.C. J. L. & Tech. On. 333 (2019), //
  • PDF: //
  • Volume: Volume 20, Online Edition