Requiring Idaho hospitals to justify the need for new services, as Gov. Cecil Andrus proposes, may sound like a good way to help rein in health-care costs, but some experts say it hasn't worked well elsewhere.

"This is, in many places, a dead issue," said Cindy Madden, associate professor in the Department of Health Services at the University of Washington. "There are so many better ways to do what needs to be done."Not everyone dismisses the proposed requirement so easily, including Andrus, who will talk about his plans in his annual State of the State address Jan. 10. Legislation is likely in the upcoming session.

After competition between Boise's two big hospitals heated up this fall, Andrus said he would favor a law giving the state a say in how and when hospitals add expensive new equipment and services.

Andrus worries about St. Alphonsus Regional Medical Center's plan to begin offering open-heart surgery in January. That will duplicate a long-standing open-heart surgery program at St. Luke's Regional Medical Center across town. No decision has been made.

Officials at St. Al's declined to comment but have said in the past that the open-heart program is justified by Boise's burgeoning population.

Unnecessary duplication of services fuels rising health-care costs. Blue Shield, the state's second-largest insurer, says hospital charges across Idaho have risen 121 percent in the past seven years. The Idaho Hospital Association says it's closer to 60 or 70 percent.

Programs to require hospitals, nursing homes and other facilities to submit new projects to review boards are nothing new. In 1991, all but 12 states had something like it, mostly variations on a defunct federal program called "certificate of need."

Idaho had such a program until the mid-1980s when the Legislature failed to renew it.

Scott Peyron, spokesman for Andrus, said Idaho's old program had some benefits, although reviving it definitely is not the answer to all of Idaho's health-care problems.

"I think you would find a significant number of people involved in the former Idaho certificate-of-need program who would say that, while it had its shortcomings, it had some elements of benefit," said Peyron. "The idea is to take the best of what we had, and try to shore up those areas of shortcomings."

In most states with the program, if a health-care provider adds a new piece of equipment or a new service that costs more than $1 million, the plan has to be run past a review panel.

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Exactly which providers and services are covered varies widely from state to state. Some apply only to nursing homes. Others leave out doctor's offices and health-maintenance organizations.

Usually, the health-care provider has to prove the new service will draw enough customers to be financially viable. If not, the plan is rejected because customers could end up paying for it through higher rates.

Howard Greenwald, professor of public administration at the University of Southern California in Los Angeles, said the programs worked better in some states than in others.

"The real question is how it's structured," he said. "It could work if you had real expertise on the part of the people carrying it out."

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