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.
Accurate and timely data on cause of death are critically important for guiding health programs and policies. Deaths certified by doctors are implicitly considered to be reliable and accurate, yet ...the quality of information provided in the international Medical Certificate of Cause of Death (MCCD) usually varies according to the personnel involved in certification, the diagnostic capacity of the hospital, and the category of hospitals. There are no published studies that have analysed how certifying doctors in Bangladesh adhere to international rules when completing the MCCD or have assessed the quality of clinical record keeping.
The study took place between January 2011 and April 2014 in the Chandpur and Comilla districts of Bangladesh. We introduced the international MCCD to all study hospitals. Trained project physicians assigned an underlying cause of death, assessed the quality of the death certificate, and reported the degree of certainty of the medical records provided for a given cause. We examined the frequency of common errors in completing the MCCD, the leading causes of in-hospital deaths, and the degree of certainty in the cause of death data.
The study included 4914 death certificates. 72.9% of medical records were of too poor quality to assign a cause of death, with little difference by age, hospital, and cause of death. 95.6% of death certificates did not indicate the time interval between onset and death, 31.6% required a change in sequence, 13.9% required to include a new diagnosis, 50.7% used abbreviations, 41.5% used multiple causes per line, and 33.2% used an ill-defined condition as the underlying cause of death. 99.1% of death certificates had at least one error. The leading cause of death among adults was stroke (15.8%), among children was pneumonia (31.7%), and among neonates was birth asphyxia (52.8%).
Physicians in Bangladeshi hospitals had difficulties in completing the MCCD correctly. Physicians routinely made errors in death certification practices and medical record quality was poor. There is an urgent need to improve death certification practices and the quality of hospital data in Bangladesh if these data are to be useful for policy.
•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.
Summary
The improvement of the energy performance of buildings is identified as one of the core challenges toward achieving a carbon‐neutral built environment. In the 2018 recast of the Energy ...Performance of Buildings Directive, the European Commission has emphasized the need for improved schemes, to ensure the best possible evaluation of the actual energy performance of buildings, taking into consideration all the parameters related both to their construction and operation. Significant research efforts have been designated in this area, to identifying the additional information required to not only improve the energy performance certification process but also to provide more thorough reports to end‐users. To increase comprehension, awareness, and thus genuine involvement, cutting‐edge digital technologies are expected to be used. The research project entitled “Next‐generation Dynamic Digital EPCs for Enhanced Quality and User Awareness” (D^2EPC GA 892984) introduces a comprehensive approach to next‐generation Energy Performance Certificates that addresses the main challenges and gaps in buildings' energy assessment process, by introducing additional layers of information for the assessor and the user. A non‐exhaustive list of the novel set of Energy Performance Certificates indicators, proposed in D^2EPC includes energy, smart readiness, wellbeing, comfort, financial, and sustainability related indicators. In this study, aspects of employing advanced digital solutions, like Building Information Modelling and Geographical Information Systems for the certification process are also demonstrated, through a well structured, high‐level, detailed representation of the next‐generation Energy Performance Certificates system architecture. This framework elaborates on individual components and their interaction, toward delivering the envisioned final enriched cloud‐based platform, that will enable dynamic Energy Performance Certificates based on (near) real‐time field data. This study aspires to initiate the discussion within the scientific community of buildings' energy assessment on the required practices for digitizing and enriching the certification process of buildings, in compliance with Industry 4.0 practices.
With electro-mobility, the demand for charging services is increasing. In Germany alone, the Federal Ministry for Digital Affairs and Transport required for at least 843,000 new charging stations by ...2030. Charging service is key for electro-mobility and requires a new innovative technology for the future. Plug and Charge (PnC) enables easy, convenient, and secure charging process compared in existing technologies (RFID, SMS, or App). This secure and convenient charging process is based on digital certificates from PnC ecosystem. Today, validation of certificates between electric vehicle (EV) and charging station (EVSE) in PnC ecosystem is very simple. For the future, there are many new requirements for PnC ecosystem from new standard (ISO 15118-20), Federal Ministry of Economics and Climate Protection, new certificates (V2G root CAs) and new Pool&Service (e.g., Root Certificate Pool). This will make the validation of certificates between EV and EVSE more and more difficult. These new and existing requirements are identified, analyzed and evaluated here. With this article, for the first time, these requirements are derived on entire PnC ecosystem, on cloud components (e.g., MO) and on individual functions (e.g., mTLS, certificate authentication, and authorization). From these requirements, a three-level solution (1-EV, 2-PKI, and 3-Cloud components (e.g., MO, CPO)) is generated. These three level solutions enable successful validation of the certificate with or without interoperability of the certificate. New and various solutions for future networks (e.g., contract and root certificate pools) for either interoperable or non-interoperable networks are illustrated here.
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