Healthcare heavyweights work system

More than 30 states tightly control healthcare services by deciding both what facilities and equipment are needed and who operates them. Such decisions are officially made in what's known as a "certificate of need," a public process subject to open meeting and records laws. But private competitors often strike back-room deals in confidential legal settlements, and even state regulators may not know the exact terms. Critics say this process favors big hospitals, which can manipulate the system and monopolize care.