Hospitals are merging and consolidating, creating large regional and national health systems. Many rural hospitals are closing or ending certain types of health services, limiting access to needed health care for communities around the country. A new national study by the MergerWatch project has concluded that state level oversight of hospital transactions in the form of Certificate of Need (CON) review is inadequate to protect consumer access to needed health services in this new era of health industry consolidation. 

Our analysis found that only a limited number of states have the CON policies that are most important for maintaining access to services when hospitals consolidate:

  • Only 10 states require review when a hospital is going to close or if a service would be discontinued.
  • Only 8 states require review for a proposed hospital affiliation that is less formal than a sale, purchase or lease.
  • Only 9 states require consumer representation on the reviewing body that decides whether hospitals can merge, downsize or close.
  • Only six states require a public hearing on applications from hospitals proposing to merge, downsize or close.

See what type of hospital merger review is required in your state. Compare your state’s policies to our model policies. See our action steps for health advocates!


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See how each state measures up