Are change tables really necessary? Not always. It all depends on your lifestyle and budget. Having a safe place to change your baby on the other hand, is important.
The traditional change table is expensive and pretty much useless once your baby is grown out of it. Did I say useless? Well maybe not so much useless but rather an eyesore. Use it as you may for storage etc, it doesn't really add to any room decor that I am aware of and quite often takes up precious space.
Having said that, if you can pick one up second hand for a reasonable price, go ahead. There is a reason why you have to be first in line at the rummage sales to get these coveted baby items. When I had my first child, I was fortunate in that my brother gave me his old one and with a little paint, we had a fresh new table for free.
However, if you can afford it why not buy a more versatile piece of furniture. Just look in any baby store these days and they are selling lovely sets of coordinating dressers with space on top for a change pad. Not only does it add to your room decor, but it's also a more mature look that will grow with your child especially if you are purchasing one of those convertible cribs. You remove the change paid and voila an ordinary dresser again.
As for the change pad, I would recommend buying a foam change pad which curves inward. It not only has a belt attached to it for securing your child but it also comes with straps at the back that you can firmly screw into the back of the dresser to insure it will stay in place. Although, I have found the foam alone sufficient for non movement.
While baby furniture can be expensive, a versatile dresser is a great investment. You don't have to stick with the baby stores either. When we were expecting our second child, I chose to go with a modest 4 drawer pine dresser from a non-baby store which was much cheaper and made out of solid pine. The bonus was that it came unfinished so I could stain it to whatever color scheme I chose. The foam pad works great and I've now been through two children with this system. I still haven't made up my mind what color to stain the dresser though. (There's that commitment issue coming up again)
I liked having the traditional table in the kid's bedrooms because I could put their diapers, baby blankets etc on it. However, because each one of our children slept in a cradle in our bedroom for the first six months or so it became a pain to take them out of the bedroom to change them all the time. That's when I opted for using the top of the dresser for a change table. The drawback being that you have to use the top drawer for their diapers and wipes. The drawback to the change table is that when the baby starts crawling, all that stuff will be tossed off the shelves before you can say "boo".
As always safety is important. Never leave your child unattended on a change table and always make sure your furniture is properly assembled and shop smart.
I'd love to hear from you on what your preferred system was.