Evolution of the Nursing Home Industry in States With Different Certificate of Need Policies

One of the earliest efforts to curb needless health care spending in the United States was certificate-of-need (CON) programs, which limit and manage the expansion of different health care institutions. CON programs mainly targeted nursing homes and home health industry that provide long-term care that is predominantly financed by states through Medicaid program. A large set of empirical studies documented that CON laws have been unsuccessful in limiting growth of hospital,1,2 nursing home,3,4 and home health5,6 spending.