Singleton: We need an honest debate about certificate of need program

July 17, 2013 


— Certificate of need programs originally were enacted to regulate the number of beds in hospitals and nursing homes, and to prevent excesses of expensive equipment. The premise was that the acquisition of new and improved facilities and equipment should be based on a genuine need in a community.

This premise was called into question by Gov. Nikki Haley’s decision to veto funding for South Carolina’s certificate of need program and DHEC Director Catherine Templeton’s decision to suspend its requirements and file a lawsuit.

But health care is not the same as other industries. Services are ordered by health-care providers for patients, whereas consumers personally shop for cars and appliances. Unlike patients, consumers are aware of the costs of the products before they purchase them and can shop for the best deal and the best quality they can afford. Patients are at the mercy of their providers and generally don’t know whether they are getting the best deal or the best quality.

In theory, certificate of need programs assist in the distribution of health care to all geographic areas, highlight areas in need of improvement and development, help control health-care spending and provide objective decisions on need rather than self-interest.

Gov. Haley and other opponents argue that these programs don’t actually control costs and may keep prices high by restricting competition; too often, certificates are granted on the basis of political influence, institutional clout and other factors besides the community’s best interests.

What we need is an objective review of the pros and cons of South Carolina’s program. We need to debate it in the context of health-care reform. We need to consider who has and does not have access to health-care services, how these services are priced and how they are paid for.

I’m not sure if health-care costs will be controlled better with or without the certificate of need program, but I am sure that we need to make South Carolina a healthier place to live, work and play. This includes ensuring that our rural, underserved populations have access to the same level of quality services available to our urban populations, and that rural providers are compensated equitably for the same level of services provided in our urban communities.

Dr. Monnie Singleton

Medical director, Singleton Health Center


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