Certificates of Need are regulations required by some states before any construction or expansion of services at medical facilities are undertaken. Originally developed to prevent excessive construction of expensive health care facilities, these rules have distorted health care markets and probably should be repealed. Karl Bilimoria, MD, from Northwestern University, Tarik K Yuce, MD, and JAMA Associate Editor Karen Joynt Maddox, MD, from Washington University, discuss the current status of these regulations and their effect on health care markets. Related Article(s): Association of State Certificate of Need Regulation With Procedural Volume, Market Share, and Outcomes Among Medicare Beneficiaries