By NextBestFitPhase 5: Stabilize & govern · Step 5.5
Plan capacity regionally
Annual · Regional capital boardsDiscuss this step
Pros & cons of this step
Pros
- +Capital goes where waits are longest, not where commercial margins are highest.
Cons
- −Central planning can be slow, captured by incumbents, or politicized.
- −Hospitals lose control of their own expansion.
- Planned allocation vs. market-driven investment.
Trade-off behind each cost item
- Structures & equipment (capital)+$168.2BPlanned capital allocation directs investment to shortage areas but can be slow or captured; Canada's central capital planning under-invested in imaging.
Trade-off behind each system change
- State certificate-of-need lawsOne national approach vs. state control.
- Antitrust enforcement for hospital and physician mergersConsolidation no longer raises prices, so more mergers may be allowed; that can still reduce patient choice and quality competition.