[FireBeyond]

> And in many cases, you can't easily open a new company because of upfront expenses. E.g.: an emergency room.

Let me introduce you to the Certificate of Need.

If you want to open a new hospital or facility like this in a town, you need a Certificate of Need from the Department of Health in your state. This ostensibly shows that there is a need for your facility because it is underserved. In actuality, it asks your competitors to say whether they'd reduce services or close beds if you opened your facility. While there is some community research etc., a lot of it comes down to "do your competitors think they can stay profitable enough if you open up shop?", and if they don't, no CoN for you.