Certificate of Need (CON) laws, currently in place in 35 US states, require certain health care providers to obtain a certification of their economic necessity from a state board before opening or ...undertaking a major expansion. We conduct the first systematic review and cost-effectiveness analysis of these laws.
We review 90 articles to summarize the evidence on how certificate of need laws affect regulatory costs, health expenditures, health outcomes, and access to care. We use the findings from the systematic review to conduct a cost-effectiveness analysis of CON.
The literature provides mixed results, on average finding that CON increases health expenditures and overall elderly mortality while reducing heart surgery mortality. Our cost-effectiveness analysis estimates that the costs of CON laws somewhat exceed their benefits, although our estimates are quite uncertain.
The literature has not yet reached a definitive conclusion on how CON laws affect health expenditures, outcomes, or access to care. While more and higher quality research is needed to reach confident conclusions, our cost-effectiveness analysis based on the existing literature shows that the expected costs of CON exceed its benefits.
Objective
To test how Certificate of Need laws affect all‐cause mortality in the United States.
Data Sources
The data of 1992–2011 all‐cause mortality are from the Center for Disease Control's ...Compressed Mortality File; control variables are from the Current Population Survey, Behavioral Risk Factor Surveillance System, and Area Health Resources File; and data on Certificate of Need laws are from Stratmann and Russ ().
Study design
Using fixed‐ and random‐effects regressions, I test how the scope of state Certificate of Need laws affects all‐cause mortality within US counties.
Principal Findings
Certificate of Need laws have no statistically significant effect on all‐cause mortality. Point estimates indicate that if they have any effect, they are more likely to increase mortality than decrease it.
Conclusions
Proponents of Certificate of Need laws have claimed that they reduce mortality by concentrating more care into fewer, larger facilities that engage in learning‐by‐doing. However, I find no evidence that these laws reduce all‐cause mortality.
•A methodology for evaluating energy performance of buildings from few input data.•Applying data filtering for energy certificate pre-processing.•Using ANN for evaluating building heat demand ...indicators.•A level of confidence is acquired by using numerous ANN models.
The Energy Performance Building Directive 91 of 2002, mandates Member States of the European Union to enforce energy certification of buildings through local legislation. Among the Italian regions, Lombardy has issued predicted energy performance certificates for buildings since 2007 which accumulate to over one million entries. The current study is an attempt to validate a dataset of energy certificates by benefitting from the magnitude of registered buildings. Considering that manual evaluation of every entry is exhaustive and time consuming, artificial neural network is used as a fast and robust alternative for predicting heat demand indicators. Various combinations of input features are compared for selecting a reliable model. The number of inputs and hidden neurons are also optimized in order to achieve better accuracy. Results show that using 12 variables from an energy certificate is sufficient for estimating the related heat demand indicator. Regarding the stochastic initialization of neural networks, a set of 100 models are trained for obtaining a frequency distribution and confidence interval. Final results indicate that about 95% of entries fall within ±3 confidence intervals.
A new paradigm regarding a significant technological development has been introduced, each individual gets full trust in controlling an asset and can see the level of authenticity of a particular ...asset. Through qualitative methods, it is possible to have structured results as the first step to the perfection of the digitalisation era, in which the current revolutionary technology called blockchain has come into play. One of the main innovations found through this research is the role of blockchain in enhancing e-certificate data security, it is proven that administration can be well distributed and reduce operational costs for every field in the world. It is clear that blockchain, especially in the world of education certification, has a big impact, because it can create a global trust network, immutable, authenticated ubiquitous, and can shape a better world for Indonesia as a superpower. With good execution using the SHA-256 hash, e-certificate blockchain technology can be of high value and have an impact on the quality of potential human resources in educational institutions.
•A novel scheme is proposed for IoT-based healthcare systems to generate and maintain medical certificates.•The proposed blockchain system ensures the security of medical certificates.•In the ...proposed scheme, the Merkle root hash of the medical certificate is maintained with a unique transaction identity.•Experimental results prove the efficiency of the proposed scheme over the existing schemes.
Nowadays, blockchain technology is one of the advanced technologies to ensure the security of users’ sensitive or confidential data. Blockchain technology plays a vital role in various applications like artificial intelligence, supply chain, cloud computing, the healthcare sector, and many more. It helps the healthcare domain to get benefitted from its many advanced features, such as confidentiality, decentralization, security, and privacy. Also, the Internet of Things (IoT) devices connect with the healthcare systems, and the healthcare sector application software further communicates with the IT industry. The blockchain-based IoT systems have significantly impacted the healthcare sector by enhancing security, privacy, transparency, and efficiency, providing better business opportunities. Moreover, traditional healthcare systems face severe security and privacy problems, such as phishing, masquerades, identity theft, and many others. Thus, a secure blockchain-based Proposed Application (PA) is designed to generate, maintain, and validate healthcare certificates. The PA acts as a communication medium between the backend blockchain network and application entities like hospitals, patients, doctors, and IoT devices to create and verify medical certificates. It also ensures various security features, namely confidentiality, authentication, and access control, using the concept of smart contracts. The comparative and performance analysis of the proposed work shows that it provides a more effective solution than the existing schemes.
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•A model is proposed to maximize market performance including tradable certificates.•The long-term impacts of regulations on market are discussed by fine and subsidy.•Three important ...objectives for government are investigated under four scenarios.•The obtained results are validated by Turkey’s energy data as a real case study.•Fine policy is more effective than a subsidy to empower renewable electricity.
In the last decades, due to the increasing environmental concerns such as energy-resource depletion and global warming, energy efficiency instruments and renewable energy production has been promoted more than ever. This paper investigates a comprehensive comparison between two energy markets, i.e., the tradable white certificate (TWC) market and the tradable green certificate (TGC) market. How to coordinate the two energy markets and what the coordination impacts become the main issues under a reward-penalty mechanism. This multi-agent problem is discussed in an electricity supply chain consisting of two populations of traditional energy suppliers who want to decide about using one of them under government intervention. In this regard, the behavior of the suppliers is analyzed under three different Scenarios, including traditional power generation, energy efficiency program (EEP), and renewable portfolio standards (RPSs). An evolutionary game is applied to formulate the problem. The results show that a mandatory fine policy is more useful than an energy-saving subsidy to motivate the traditional suppliers to move toward sustainable energy generation. This policy also helps governments to meet their sustainable-oriented goals, as we discussed in this work. The findings can be applied to extend sustainable-based energy projects in developing countries.
That the status of land ownership in Indonesia is still not completely registered, for example customary landin a few Territories in Indonesia are still not registered, so in order to obtain proof of ...land ownership, parties who control customary property rights must submit an application for land registrationfirst time through the local land office. Often, in several cases, customary land cannot be registered due to various reasons, such as a lack of information or the unavailability of a fee to register the land. Customary land that has not been registered will result in the vulnerability of land disputes or conflictsin later days, and this is anticipated by establishing a Complete Systematic Land Registration procedure by the Government through the Ministry of Agrarian Affairs and Spatial Planning with the APBN/APBD budget. The purpose of this legal research is nothing elseis as a means of adding knowledge in the field of law which is expected to be of benefit to practitioners and the public. Methods This legal research uses a normative juridical research method which is carried out by examining literature or secondary data using a conceptual, statutory and case approach. The results of this study are that PTSL can be a solution for the Government in completing the programcertification all plots of land that exist on Indonesian soil and can prevent and know which land plots will have the potential for conflict, the benefits of PTSL can also reduce the potential for misconduct by village officials in providing land history documents or proof of physical ownership of customary land. That PTSL has a series of procedures that are passed by involving the village to get maximum results in issuingcertificate which is the spearhead of the PTSL activities. The series of PTSL procedures, namely planning, location determination, preparation, formation and determination of the PTSL adjudication committee and task force, counseling, collection of physical data and collection of juridical data, research on juridical data to prove rights, announcement of physical data and juridical data and their ratification, confirmation of conversion, recognition of rights and grant of rights, bookkeeping of rights, issuance of certificates of land rights, documentation and submission of activity results and reporting.
The article discusses the framework of Maintenance of Certification (MOC) over the years, the necessary changes in it, and the resentment faced by MOC due to irrelevant requirements. The ...recommendations to the MOC are suggested by the physicians that might help in the passing of Certification.
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