Iowa’s Certificate of Need a key to accessible, affordable healthcare

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Photo courtesy the Dallas County Hospital

Iowa has one of the highest-quality, lowest-cost healthcare systems in the U.S., and at the heart of that system are 118 community hospitals that stand ready, day and night, to serve everyone regardless of their ability to pay.

A significant reason for healthcare excellence in Iowa has been state oversight of institutional health care services through the Certificate of Need law.


Iowa’s Certificate of Need regulations were first enacted in 1977 for the purpose of facilitating orderly and economical development of health care services and avoiding unnecessary duplication of services by controlling the growth of overall healthcare costs and ensuring the stability of community hospitals.

Since that time, these regulations have been re-examined multiple times, and each time the same conclusion was reached: Iowa needs its Certificate of Need law.

As the name implies, Certificate of Need ensures that new medical services are truly needed at the community level. This is important because new facilities — including nursing homes, ambulatory surgical centers and hospitals, among others — must have sufficient patient volumes to support proficiency among medical staff and ensure high-quality care.

The same applies to existing facilities, yet without Certificate of Need, new, for-profit facilities would spring up all over the state and deplete patient volumes across the board.

Not only would this compromise the quality of care for everyone, but these new facilities would target lucrative lines of medical service while not providing emergency care, charity care and other unprofitable services that are at the core of the community hospital mission.

If Iowa’s community hospitals are left with only unprofitable services and only care for complicated patients who are on Medicaid or uninsured, their ability to survive and continue providing high-quality, community-focused care to everyone will be jeopardized.

“At Dallas County Hospital, we pride ourselves on being committed to providing quality, affordable care close to home and helping throughout the community,” said Angela Mortoza, chief executive officer of the Dallas County Hospital.

Repeal of the law in other states has led to closed hospitals. In fact, nearly all of these states have instituted a different review process that is highly politicized.

One of Iowa’s greatest strengths is its healthcare system. Not only do Iowa’s healthcare providers deliver excellent, accessible and efficient care, but healthcare employs more than 200,000 people, injecting some $11 billion into the state’s economy. More than 71,000 of these workers are employed by hospitals, which alone have an economic impact of $4.3 billion.

The Certificate of Need, which exists in 36 states, not only ensures the stability of these major employers and crucial economic engines, but it also supports a collaborative spirit that fosters communication and cooperation among Iowa healthcare providers — again, leading to better healthcare for everyone.

Today, with the uncertainties surrounding the future of the Affordable Care Act (Obamacare), Iowa’s Medicaid program and even Medicare, the constancy of the Certificate of Need law is more important than ever. During this time of significant change in the healthcare industry, the stability provided by this law allows hospitals to plan more confidently and respond to the needs of the communities they serve.

In all parts of the state, Iowans count on their community hospitals to be there all day, every day. That level of access and preparedness is jeopardized by those who would significantly change or repeal Iowa’s Certificate of Need law.

Macinzie McFarland is the public relations manager at the Dallas County Hospital.

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