Written by Sheryle Pinson
I read LINK nky’s super issue detailing healthcare in Northern Kentucky and found no mention of the debate regarding Certificate of Need (CON). (CON programs empower the state to control the number and type of healthcare resources available in a given area.) Why was this vital conversation omitted?
On page 10 of the super issue, the article “Money and medicine: How financial incentives are reshaping the face of medical institutions,” began with this list: “TriHealth, St. Elizabeth, Christ Hospital, Cincinnati Children’s, Mercy Health, UC Medical Center.”
Apart from St. Elizabeth Healthcare, those corporate umbrellas cover Good Samaritan Hospital, Christ Hospital, UC Medical Center, Jewish Hospital, Bethesda North Hospital, West Hospital, Anderson Hospital, and Cincinnati Children’s Hospital Medical Center.
All those healthcare companies and their hospitals are based just north of the river. Their umbrellas do extend to satellite facilities on the NKy side of the river, such as Cincinnati Children’s Urgent Care, Inpatient Behavioral Health and various physicians’ offices, but only St. Elizabeth maintains general hospitals in Northern Kentucky.
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Ohio also has Certificate of Need legislation, so how can Greater Cincinnati offer so many hospitals when Northern Kentucky offers only one? According to the Institute for Justice, Ohio requires CON for only one service. Kentucky requires CON for 32. (1)
Congress tied Certificate of Need to federal funding with the 1974 National Health Planning and Resources Development Act. As with most government programs, good intentions ran into the pitfalls of central planning and top-down regulation. In a rare moment of legislative insight, Congress eliminated the CON mandate in 1987. Twelve states repealed or chose not to renew their CON programs and others dramatically revised them—and for good reason. “To date there have been 45 empirical assessments of CON and spending per service. Sixty percent associate CON with higher spending per service, while just 7% associate CON with lower spending per service. The rest find negligible results.” (2)
Rep. Marianne Proctor has introduced legislation that would revise, not eliminate, Kentucky’s CON. The revision would “limit the ability to request a hearing before the Cabinet for Health and Family Services to certificate of need applicants. Currently, all ‘affected persons’ may request a hearing but they no longer would have that right under the proposal.” (3)
Who are the “affected persons” that can challenge another company’s desire to do business in Northern Kentucky? According to current CON law, they include “health facilities located in the health service area in which the project is proposed to be located which provide services similar to the services of the facility under review; [and] health facilities which, prior to receipt by the agency of the proposal being reviewed, have formally indicated an intention to provide similar services in the future[.]” (4)
How does opposition from an “affected person” affect the outcome of a CON application? For those for which the Kentucky Cabinet for Health and Family Services must assess need, “the approval rate for unopposed substantive review applications was 84% but was nearly cut in half, to 43%, for opposed applications.” (5) Responding to opposition often requires a lengthy and costly legal battle.
Did Kroger have a legislated right to inject its weighty influence into consideration of Publix’s expansion into Northern Kentucky just because Kroger already exists here, is also a grocery store, and promises to offer a service they don’t offer now? The market will decide whether Publix made a good decision, and I expect Kroger will try harder to retain me as a customer. Competition will ensure it. Competition will force both companies to keep costs in line, innovate, and up their customer service game.
In any industry, competition means companies either identify unmet needs in existing markets and go head-to-head with existing providers or identify new markets where needs aren’t being met. Competition should be allowed to flourish in healthcare as well.
References:
(1) https://ij.org/wp-content/uploads/2023/08/Kentucky-CON-Report-Aug.-2023.pdf
(2) https://pmc.ncbi.nlm.nih.gov/articles/PMC11088301/
(3) https://linknky.com/news/2026/03/12/no-such-thing-as-a-competitors-veto-and-other-arguments-as-kentucky-con-debate-renews/
(4) https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=56419
(5) https://ij.org/wp-content/uploads/2023/08/Kentucky-CON-Report-Aug.-2023.pdf