Barriers to Coordinating Health Services Regulatory Programs

State and federal health services regulatory programs have proliferated over the past ten years, but little attention has been paid to their coordination to ensure that they reinforce rather than obstruct each other. Four approaches taken by states to coordinate certificate-of-need and prospective rate or budget review programs are examined here. Technical, administrative, and political factors are found to impede close working relations between the programs. Some coordination procedures may even exacerbate program weaknesses and diminish regulatory impact. The current configuration of political support for the programs makes policy changes to facilitate program coordination rather unlikely.