Decade of decision: Explaining hospital certificate of need decisions: The case of HSA II in New Jersey, 1978-1988

Gwenn Karel Levine, Fordham University


The traditional use of a single conceptual framework at a time to analyze decision-making has provided inadequate explanations of decision-making processes and has been self-confirming, as well. Such one-dimensional studies of decision-making failed to use alternative conceptual frameworks simultaneously and to view different models of decision-making as complementary rather than mutually exclusive. In the mid 1970s, Graham Allison and Paul Peterson published studies which broke new ground by analyzing foreign policy and urban school politics, respectively, using alternative decision-making models simultaneously. These models were the rational, organizational process, and political bargaining models of decision-making. It was the goal of this dissertation to go beyond Allison and Peterson by applying alternative decision-making models to a different policy arena--health planning--and by testing specific hypotheses related to each model in order to draw conclusions regarding the relative efficacy of each model in explaining decision-making. This analysis focused on decisions made by The Regional Health Planning Council (HSA II) in New Jersey regarding hospital certificate of need applications. It was discovered that the rational and the political bargaining models were not only complementary, but also interrelated. This came to light in the examination of the effect of regionalization of services and of controversy on decisions made by the HSA Board of Trustees. The regionalization of services, which set limits on the number of hospital certificates of need which could be endorsed for certain high cost, high tech services, was a measure of the rational decision-making model. Controversy, the result of hospital competition for scarce resources, was a measure of the political bargaining model. Limit-setting was the link between the two because the scarcity it created forced choices to be made (rational model) while, at the same time, creating competition for scarce resources (political bargaining model). Of further interest was the unexpected discovery that hospital influence and clout tended to be a disadvantage in the effort to achieve certificate of need endorsement. Thus, this research challenged and reversed deeply entrenched assumptions about the certificate of need decision-making process.

Subject Area

Political science|Health care

Recommended Citation

Levine, Gwenn Karel, "Decade of decision: Explaining hospital certificate of need decisions: The case of HSA II in New Jersey, 1978-1988" (1992). ETD Collection for Fordham University. AAI9223820.