Date of Award


Document Type


Degree Name

Master of Arts


Political Science


It is the central argument of this thesis that the cost of medical care has been the most salient political consideration in the evolution of certificate of public need Virginia. Certificate of need is a regulatory mechanism that public officials use to achieve health planning goals by controlling medical facility capital expenditures. This thesis sets the development and implementation of certificate of need in Virginia against the broad background of medical facility public policy in this country, as well as significant political movements in Virginia.

Several themes are evident from this analysis. Over time, the center of medical facility planning and assistance has shifted from the private sector to state and local governments, and then to the federal government. More recently, governmental activity in this area has reverted to the states. Secondly, the nature of this activity has changed from health facility construction assistance to health planning, and finally to health facility regulation. Group interaction has played an important role in the overall development and administration of the certificate of public need in Virginia. The review process itself has numerous points of entry for public participation. Finally, several facets of the ever-changing healthcare environment have influenced and are influenced by Virginia's certificate of public need program.