The way Maryland regulates the expansion of hospitals, nursing homes and other health-care centers and services is about to get a much-needed exam of its own.

The Maryland Health Care Commission is soon to name a task force to study how it grants, or denies, permission to add new hospital beds or expensive services, such as open-heart surgery suites or burn-care units.

For decades, health-care providers have had to apply for a "certificate of need" from the state, providing reams of reports to justify new buildings or specialized services.

Regulators take time to look at not only the need in an area, but also at the economics of the proposals. One goal is to ensure that hospital beds are filled as often as possible and that the level and type of service is appropriate, not overbuilt.

For as long as it has been issuing the certificates, the commission has been a target of criticism.

Some argue that the regulations allow health-care monopolies and restrict newer, better medical technologies.

Hospitals that compete in the same territory, or for the same medical niche, sometimes find themselves locked in months-long skirmishes with neighboring hospitals over expansion.

Shady Grove Adventist Hospital, for instance, is in the process of asking Maryland lawmakers to allow it to open a freestanding emergency room in Germantown. The hospital's executives took the somewhat unusual step of appealing to the state legislature after health regulators refused a certificate for the ER, which would be one of the first of its kind in the state. In the 1990s, Shady Grove met opposition from other Montgomery County hospitals when it sought to open a rehabilitation center for seriously disabled patients at its Rockville hospital campus.

Three other hospitals are in a winner-take-all contest for the right to set up a specialized heart surgery center. Suburban Hospital in Bethesda, Holy Cross in Silver Spring and Clinton's Southern Maryland Hospital Center are all making a case for the coveted certificate. What's not in dispute is the need for another open-heart center in Maryland.

The executive vice president of the Clinton hospital, Michael J. Chiaramonte, says eight out of 10 heart patients from Southern Maryland now go to Washington Hospital Center, miles away in the District, for treatment.

Powerful lawmakers argue their constituents need quality, specialized services closer to home.

"Southern Maryland is woefully neglected in this process," Senate President Michael V. Mike Miller Jr., a Democrat from Chesapeake Beach, told The Gazette's Margie Hyslop. "We've got to bypass 60 to 75 miles to go to Prince George's Hospital Center, which is woefully inadequate."

Managing health care -- either at nonprofit or for-profit centers -- remains a serious, complex endeavor. Johns Hopkins Medicine last month received a certificate for new and replacement medical buildings in Baltimore. Price tag for the project: $578 million.

Hospitals don't rush into major expansions, which require huge investments and years of planning.

Like never before, insurers are forcing changes in care, in part to drive down costs. Patients are becoming more sophisticated about their treatment opinions. Rapid advances in technology continue to bring about better ways to treat the sick and injured. Some procedures that a decade ago would have required an overnight hospital stay are now routinely performed in ambulatory surgery centers, with the patient sent home the same day to recuperate.

Maryland's health-care regulations appear to be in the middle of the pack when held up against those in other states. That doesn't mean Maryland's rules are perfect, or even appropriate, as the health-care industry evolves. They provided a certain degree of checks-and-balances in an era when health care was simpler.

A checkup of Maryland's rules is in order, and should be done regularly, just like a physical examination. Regulators need to acknowledge the importance of evolution in the marketplace and technology. At the same time, they must strive to keep hospitals financially healthy, with minimally invasive policies and procedures.