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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., (© Health Research and Educational Trust.)

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Purpose: This paper describes the use of a high-performance team model in the leadership of a healthcare construction project with a vision of fostering innovation in the design and building process. This model facilitated the effective implementation of = Lean principles and a joint governance model combining stakeholders under a shared vision., Background: The healthcare facility discussed is a California healthcare district in San Diego. Because of state seismic safety legislation, the district elected to build a replacement hospital for its tertiary care trauma facility. The organization's leadership decided to pursue a course that demanded innovation in both the design and construction process. The owner, architects, construction manager, and trade contractors adopted a high-performance team model to meet this challenge., Conclusions and Recommendations: The governance and leadership of a construction project should reflect the design and ultimate intent of the facility. The vision of building the most innovative hospital under constrained resources required the implementation of an innovative approach to leading the construction process.

Objective: This is the third of three reports on the follow-up review of mental health care at Helen Joseph Hospital (HJH). The study reviewed existing South African standards for mental health care facilities. Architectural principles and implications for the use of space were deducted from recent legislation. Objectives were to evaluate the use of space in the existing physical facilities, to identify appropriate architectural solutions considering identified human rights requirements and to provide provisional cost estimates to align the unit towards its designated functions., Method: Personal interviews were conducted. An on-site assessment and survey was made of existing and potential new spaces., Results: Spatial requirements for implementing the Mental Health Act, No. 17 of 2002 (MHCA) were explored. Principles for spatial design of acute facilities include that: - spaces should communicate clear individual identity; - space should be segregated into zones according to user functionality and privacy; - communal leisure spaces should open into safe contained outdoor spaces; - circulation routes should preferably be circular; - sufficient visual connection should exist between circulation space and group activities; and - open lines of sight should be provided to all access points. The potential options for extension included: - an extensive unused single storey structural shell for a potential office wing on the same floor; - a huge vacant double volume space which could be accessed across the existing flat roof for potential occupational therapy activities; and - the existing roof area could be altered and secured to become an adequate outside leisure and garden area. A proposed concept design in two phases - based on these principles - was submitted to hospital and provincial management., Conclusion: To implement the MHCA without violating the human rights of mental health care users at HJH will require specific adjustment and extension of the current use of space at HJH.

This article explores the development of post-soviet hospital design through the analysis of recent modernisations in Moldova and Ukraine. It consists of two parts. First, an introduction of the definition of hospital design as well as its main characteristics during the Soviet period. Secondly, a presentation of two hospital modernisations in Ukraine and Moldova. In a comparative perspective, the paper presents the actors involved, the difficulties in modernising the hospital regarding the inherited rules as well as the solutions advanced in order to implement a change. An introduction to the hospital design in Moldova and Ukraine will allow an in-depth study of the involvement of international actors in the post-communist transformations.

This article examines the development of Certificate of Need (CON) legislation in the United States. Over time, CON legislation developed into efforts to contain rising health care costs, while maintaining quality of care. In recent years, numerous states have begun to reevaluate the current impact of CON regulations, and ask whether the programs should be discontinued. State regulators as well as academic researchers must address the costs vs. benefits of such legislation. Specific measures within such regulations must be addressed in order for health policy makers, administrators, and researchers to help meet the escalating demand for health services.

CON reforms were approved in Florida, Georgia and Iowa this year, and other states are also looking at ways to promote competition. While some observers don't see a move to sweeping change, it's a trend that draws applause. "There's no plausible argument that certificate of need meets its intended purpose. Instead, it denies access and it denies choice," says consultant Robert James Cimasi, left!

This interim final rule with comment period sets forth the criteria for implementing a loan program for qualifying hospitals engaged in research in the causes, prevention, and treatment of cancer as specified in section 1016 of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) (Pub. L. 108-173). Specifically, this rule establishes a loan application process by which qualifying hospitals including specified entities may apply for a loan for the capital costs of health care infrastructure improvement

The Disability Discrimination Act (1995) protects disabled people from discrimination in access to services, facilities and goods as well as in education and employment. All hospitals have an inherent duty to enable access to services but this will now be enshrined in law. As the health sector has most contact with disability, it may be expected that most hospitals would already be in a good position to comply with the Act, especially one treating many patients with disability. However we identified many problems in a rehabilitation hospital setting by means of a simple access audit in March 2004. Recommendations were set out and by March 2005 considerable improvements had been made costing Pound 100,000. Although many necessary changes will be expensive, not all problems identified require costly correction. Many simply involve a change in staff attitudes and practices. We recommend that all hospitals start to identify the changes needed under the Act by means of a simple access audit that can be carried out by hospital staff with no specialist equipment.

New regulations concerning the management of asbestos in non-residential properties came into force in May last year, and this 'Duty to Manage' legislation means that duty holders should be managing their asbestos adequately by fulfilling certain criteria. Inadequate management of asbestos could lead to heavy fines. Special report by Peter Harris, client services manager, Redhill Analysts.

As state lawmakers diluted the impact of certificate-of-need laws last year, more and more CON boards are approving a vast array of projects. Almost one-third of the 27 states that regulate acute-care hospitals gave the OK to every project they reviewed. Condell Medical Center, Libertyville, Ill., shown at left and on the cover, spent $99,300 three years ago to win state approval for its expansion project.

Communication deals with the complexity of planning a new hospital. We considered basic requirements needed to build this kind of settlement according to regulations in force and standards, with particular care to patients and workers safety and health, both during normal activity periods and in case of ordinary and extraordinary maintenance.

Our communication wants to stress the importance of choices which must be carried out during the planning stage in order that building works (and especially building hospitals) are realized in a safe environment. It is particularly emphasized the relationship between the regulation in force in matter of public building contracts and that in matter of safety in building process, both in case of new buildings and in case of ordinary and extraordinary maintenance.

The Emilia Romagna Region decided own accreditation and procedures pattern following decisions, by different levels and graduated stages: authorization, institutional accreditation and finally contractual agreements. For Emilia Romagna Health Administration, authorization step represented "the necessary minimum level of security to exercise health activity", carried out by self evaluation of general and specific requirements of health structures, outlined by specific check-list, to bring about the maximum time allowed five years realization of structure adjustment plans. Beginning from this context the Local Health Unit of Modena, introduced by an audit test of conformity levels caught up, the guide line of computer management of technical assistance, change to use or amplification of health permission of structure and installations take a census by the business administration. The method allows by operative guide lines standardization to certify the validity of innovations realized, in all Departements/Services, for own conformity of structures, plant design and installation, sanitary regulations and security for wards services, auxiliary rooms. The development of this method allow to link activity and professionality for different duties of supervision and inspection, to guarantee the maintenance of levels assurance of health structures.

The main contents of a Hygienic-Sanitary report are listed below, once a few premises on the definition and objectives of hygiene, and on the normative pertaining Hygienic-Sanitary reports in the context of sanitary constructions planning are set. A hospital is a complex organism, and it must be planned as an "organized system" in which the various activities are disposed in the functional spaces according to a well-defined layout. In a Hygienic-Sanitary report, one should always remember that the correct approach to a hospital construction or restructuring project must be first urbanistic, with a precise diagram of fluxes and functions, and only then architectonic, with the consequent hospital typology. Different organizational models of the functional zones and of the relative traffic fluxes correspond in fact to different architectonical typologies.