The health care market is constantly evolving with changes in hospital and provider ownership and investment. Some of these changes are the result of mergers and acquisitions, but most are smaller transactions, agreements, and contracts that do not trigger anti-trust protections but lead to decision-making shifts. Increasingly, state officials are seeking to understand the business dynamics in their health care market. Developing and implementing a market oversight strategy is one way to increase transparency of provider ownership and even incorporate state review of proposed transactions.

This chart offers a state-by-state overview of the spectrum of approaches currently in use. State goals for oversight differ, which is reflected in the scope of authority they have and in which office has the oversight responsibility. See below for more details.