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1*   The certificate of needs (CON), was put into place to be used as a cost control device for the states to override any unnecessary repetition of medical services that could run high cost. The challengers of the CON argues that facilities that are developed in a free market increase competition and in doing so the process are kept low, but there is a powerful countervailing disagreement, known as ‘Roemer’s Law, that  suggest that a built bed is a filled bed is a billed bed (Lemov,2003).  Researchers have found some evidence that CON implementation made a small decrease in spending on acute care, but by removing CON laws did not lead to an increase in these areas’ costs.  It was found that CON laws may have increased Medicare expenditures. According to studies published by Drs. Grabowski, Ohsfeldt, and Morrissey [iii], CON has been unsuccessful at controlling the costs of Medicaid long-term care expenditures. The program has failed to implement its “fundamental premise” of controlling healthcare costs (Inman, 2011) . Three states that require a CON be submitted to the state and regional review agencies for any new or upgraded healthcare facilities are: Alabama, Mississippi and Tennessee.

2*  Certificate of Need (CON) is a program that is in place to gain control over wasteful spending in the area of health care facilities, and also the utilization of coordinated planning of new services and construction. According to the National Conference of State Legislation (2011), In 1974 Federal Act required all 50 states to a CON program, which to submit proposals and obtain approval from their state health planning agency in order to begin any major capital projects such as building expansion or ordering new high- tech devices. The CON program was accepted by many states because of its incentives that it offered (from the CON federal funds). According to Simpson, 1985, “Every state CON law incorporates this rationale by providing for allocation of certificates on the basis of community "need", not consumer demand” (p.1225). One advantage of the CON program is that it eliminated overbuilding of facilities which help to keep health care prices down. Second advantage is CON focused on providing new improved facilities and equipment to those communities that really was in need.  These facilities provide services for the underprivileged and poor communities. Disadvantages of CON programs according to the opponents are unfair restrictions on existing facilities and new competitors; no real proof that over capacity or duplication lead to higher charges. Rules and regulation are needed to control cost and assure that those in need of health care services get quality care at an affordable price.

3*  Tort reform seems to be hurting both parties, in my opinion.  Tort reform promised that restricting victims’ ability to bring medical malpractice suits would improve healthcare and reduce its cost (Cohen, 2015).  A lot of patients are afraid to speak up when they feel they were mistreated because of the repercussions they might face.  There has been some instances where doctors will refuse to see patients when they are known to file suits against others.  In the states of Massachusetts and Oregon, they recently initiated avant-grade processes known as Disclosure, Apology, and Offering “DA & O” (Roslund, 2014).  This focuses on early intervention in an effort to avoid costly litigation.  Something I found interesting was the reform critics argue that the problem is not the rising numbers of lawsuits, but instead the problem lies on the insurance companies bad investments and that stocks haven’t been the greatest.  The way insurance companies are making up for these bad investments is by increasing the rates for all.  Insurance companies, in my opinion, have always been money hungry and try to find ways to make more money.  Tort reform hurts both parties.  In the closing of the article, it discusses other options that should be heard.  For example, doctors who are found to be negligent and injured patients should see their rates increase while those that practice patient safety should see their rates remain low (Ivanhoe ,2003).  I believe that option could be the answer to the angle tort reforms should take.

4*  Tort Reform is selected to benefit the medical practitioners. If those that are in the medical field make a misdiagnosis and the patient are harmed or are harmed in other ways, doctors have malpractice insurance that helps with any legal action that they may encounter with patients. In turn, the government places a cap on the amount of money that a patient is allowed to go after in a malpractice suit. This is unfair to some patients because the amount of pain and suffering as well as loss that they may encounter may add up to a lot more than the amount that has been set within the cap in the tort reform. By placing these caps, medical institutions may be affected because people may choose not to seek medical attention from their organization as well as the organization may have to pay large amounts in malpractice insurance to cover their health care professionals against malpractice. By placing all this money toward these items, medical institutions may have to in the future close their doors for good because they are unable to pay the large amount of money that is needed to keep the insurance. Because the health care field is such a tricky field to be in and people’s lives are in the hands of others, those that are providing medical care must have a means to protect themselves as well as their assets. However in protecting these things, they are also able to possibly cause harm to others at the fault of their own and the patient that suffers the loss is then left to fend for themselves in order to seek a means of repayment for the loss from the medical professional. These losses can be very great and some that are beyond the amount of any money. So, although tort reform is designed to keep physicians and other medical professions safe, it can in turn be harmful to the patients that have experience a tremendous loss. (AMA, 2003)

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