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Total hospital expenditures and network participation are important determinants of whether CAHs provide certain imaging services. Encouraging CAHs' participation in larger systems or networks may facilitate access to highly specialized services in rural and underserved areas.

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PurposeThis study aims to analyze the trends for crime and STDs after the passage of massage therapist licensing. In 1977, Texas passed a law permitting county-level licensing laws for massage therapists, which was soon followed by a statewide licensing requirement in 1985. This early massage therapy law was upheld by the Fifth Circuit Court of Appeals. Massage therapy licensing is commonly associated with preventing crime, specifically prostitution. However, massage parlors also represent an opportunity for entrepreneurs starting businesses, who face significant barriers to entry across the USA.Design/methodology/approachThe authors analyze the effect of state- and city-level licensing of massage therapists on crime and the spread of sexually transmitted diseases using data from the FBI Uniform Crime Reports from 1985–2013 and the Centers for Disease Control and Prevention between 1993-2015.FindingsThe authors find that state- and city-level licensing of massage therapists was not associated with preventing crimes related to prostitution or reducing sexually transmitted diseases. This analysis is consistent with the hypothesis that relaxing the stringency of massage therapist licensing would not lead to increases in crime or additional spread of disease while likely encouraging entrepreneurship.Originality/valueThis study is one of the first to examine the effects of city-level licensing on health and safety of consumers.