Certificate of Need (CON) laws have been used in the United States since the 1960s to restrict the availability of new and expensive technology in the health system. However, as medical technology is used in non-institutional settings, the value of such a regulatory system is called into question. This article examines changes occurring in the health system in the United States and OECD countries such as the movement of technology out of the hospital, the push by manufacturers of medical equipment to have greater sales and expand their markets, the internecine fights between different specialties, and other issues that have served to lead to an out-migration of services from hospitals to physician's offices, clinics and group practices, and specialty hospitals. The future of CON as a form of regulation is discussed.