The impact of certificate of need programs on neonatal intensive care units

J Perinatol. 2012 Jan;32(1):39-44. doi: 10.1038/jp.2011.47. Epub 2011 Apr 28.


Objective: To determine the impact of state certificate of need programs (CON) on the number of hospitals with neonatal intensive care units (NICU) and the number of NICU beds.

Study design: The presence of a CON program was verified from each state's department of health. Multivariable regression models determined the association between the absence of a CON program and each outcome after controlling for socioeconomic and demographic differences between states.

Result: A total of 30 states had CON programs that oversaw NICUs in 2008. Absence of such programs was associated with more hospitals with a NICU (Rate Ratio (RR) 2.06, 95% CI 1.74 to 2.45) and NICU beds (RR 1.96, 95% CI 1.89 to 2.03) compared with states with CON legislation, and increased all-infant mortality rates in states with a large metropolitan area.

Conclusion: There has been an erosion of CON programs that oversee NICUs. CON programs are associated with more efficient delivery of neonatal care.

MeSH terms

  • Certificate of Need / statistics & numerical data*
  • Government Regulation
  • Hospital Bed Capacity / statistics & numerical data*
  • Humans
  • Intensive Care Units, Neonatal / statistics & numerical data*
  • Multivariate Analysis
  • Regression Analysis
  • Socioeconomic Factors
  • State Government
  • United States