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The number of obstetric departments in German hospitals has declined in the last decades. In particular, rural hospitals are challenged to sustain their delivery services. In this paper, we analyse the role of variation and overheads of obstetric departments from the perspective of current and future German hospital financing. For this purpose, we develop a Monte Carlo simulation model that analyses the workload of the labour room and the obstetric ward. The results show that a hospital with less than 640 deliveries per year cannot break even. In order to offer services 24 h per day, 365 days per year, five nurses, five midwives, and five gynaecologists are needed. This results in high fixed costs. At the same time, the variation coefficient of the labour room and the obstetric ward declines with an increasing number of deliveries. Consequently, small hospitals have a higher risk of over- and under-utilization in the course of the year. This paper acknowledges that economics is not the only decision dimension. The quality of the institution and the transport to the hospital have to be considered, as well as the population's wish for nearby services. However, the simulations clearly demonstrate that unless the hospital financing system is changed fundamentally, the decline in the number of hospitals offering delivery services will continue. [ABSTRACT FROM AUTHOR]

The hydrogen (H2) momentum affects the aviation sector. However, a macroeconomic consideration is currently missing. To address this research gap, the paper derives a methodology for evaluating macroeconomic effects of H2 in aviation and applies this approach to Germany. Three goals are addressed: (1) Construction of a German macroeconomic database. (2) Translation of H2 supply chains to the system of national accounts. (3) Implementation of H2-powered aviation into the macroeconomic data framework. The article presents an economy-wide database for analyzing H2-powered aviation. Subsequently, the paper highlights three H2 supply pathways, provides an exemplary techno-economic cost break-down for ten H2 components and translates them into the data framework. Eight relevant macroeconomic sectors for H2-powered aviation are identified and quantified. Overall, the paper contributes on a suitable foundation to apply the macroeconomic dataset and to conduct macroeconomic analyses on H2-powered aviation. Finally, the article highlights further research potential on job effects related to future H2 demand. • The hydrogen momentum affects the aviation sector, but a macroeconomic perspective is currently lacking. • This article derives a methodology for evaluating the macroeconomic effects of hydrogen use in aviation and applies this approach to an economy-wide dataset for Germany. • The study investigates three hydrogen supply pathways, provides an exemplary cost break-down for ten hydrogen components and translates them into a national data framework. • Eight macroeconomic sectors relevant for hydrogen-powered aviation are identified and quantified by assigning the respective techno-economic cost components. • The article highlights meaningful research potential on macroeconomic analyses of hydrogen-powered aviation and employment effects related to future hydrogen demands. [ABSTRACT FROM AUTHOR]

While promoting the economic growth, energy has also brought pollution problems to the world environment, which has gradually become a bottleneck impeding sustainable economic development. In view of the rapid evolution of urbanization and industrialization, economic growth is increasingly dependent on the energy consumption, the development of the two is difficult to coordinate, and the internal contradictions are becoming increasingly serious, which hinders the sustainable development of economic growth. This study establishes the relationship between energy consumption and economic growth according to the energy Kuznets curve and studies the future trend of China's sustainable development through the comparative analysis of the energy Kuznets curve of the United States and Germany. The results show that, at the turning point of energy consumption, China's energy economic rate is higher than that of Germany and the United States. In addition, in terms of urbanization rate and industrial structure, although China's tertiary industry has made a breakthrough, it is still lower than that of the United States and Germany, but the level of urbanization rate has made significant progress. In short, China has obvious advantages in future economic development and has a late developing advantage compared with the United States and Germany. This paper makes an empirical analysis of the relationship between energy consumption and economic growth in OECD countries and finds out the turning point of energy consumption, so as to provide a theoretical basis for coordinating China's energy consumption and economic growth. [ABSTRACT FROM AUTHOR]

In December 2019, the Digital Health Care Act ("Digitale-Versorgung-Gesetz") introduced a general entitlement to the provision and reimbursement of digital health applications (DiGA) for insured persons in the German statutory health insurance. As establishing a new digital service area within the solidarity-based insurance system implies several administrative and regulatory challenges, this paper aims to describe the legal framework for DiGA market access and pricing as well as the status quo of the DiGA market. Furthermore, we provide a basic approach to deriving value-based DiGA prices. To become eligible for reimbursement, the Federal Institute for Drugs and Medical Devices evaluates the compliance of a DiGA with general requirements (e.g., safety and data protection) and its positive healthcare effects (i.e., medical benefit or improvements of care structure and processes) in a fast-track process. Manufacturers may provide evidence for the benefits of their DiGA either directly with the application for the fast-track process or generate it during a trial phase that includes temporary reimbursement. After one year of \]reimbursement, the freely-set manufacturer price is replaced by a price negotiated between the National Association of Statutory Health Insurance Funds and the manufacturer. By February 2022, 30 DiGA had successfully completed the fast-track process. 73% make use of the trial phase and have not yet proven their benefit. Given this dynamic growth of the DiGA market and the low minimum evidence standards, fair pricing remains the central point of contention. The regulatory framework makes the patient-relevant benefits of a DiGA a pricing criterion to be considered in particular. Yet, it does not indicate how the benefits of a DiGA should be translated into a reasonable price. Our evidence-based approach to value-based DiGA pricing approximates the SHI's willingness to pay by the average cost-effectiveness of one or more established therapy in a field of indication and furthermore considers the positive healthcare effects of a DiGA. The proposed approach can be fitted into DiGA pricing processes under the given regulatory framework and can provide objective guidance for price negotiations. However, it is only one piece of the pricing puzzle, and numerous methodological and procedural issues related to DiGA pricing are still open. Thus, it remains to be seen to what extent DiGA prices will follow the premise of value-based pricing. [ABSTRACT FROM AUTHOR]

An increasing number of municipalities are striving for energy autonomy. This study determines in which municipalities and at what additional cost energy autonomy is feasible for a case study of Germany. An existing municipal energy system optimization model is extended to include the industrial, commercial and personal transport sectors. Multiple regression methods are benchmarked in order to identify the model best suited for the transfer of individual optimization results to a large proportion of German municipalities. The resulting levelized cost of energy (LCOE) from the optimization of representative case study municipalities are transferred using energy-relevant indicators. The study demonstrates that energy autonomy is technically feasible in 6,314 (56%) municipalities. Thereby, the LCOEs increase in the autonomous case on average by 0.41 €/kWh compared to the minimum cost scenario. Apart from energy demand, base-load-capable bioenergy and deep geothermal energy have the greatest influence on the LCOEs. Overall, it appears that municipal energy autonomy is not economically viable under current framework conditions. This study represents a starting point for defining possible scenarios in studies of future national energy system or transmission grid expansion planning, which for the first time consider completely energy autonomous municipalities. [ABSTRACT FROM AUTHOR]

Design: A cross‐sectional study was conducted in December 2020/January 2021 in the five significant cities of Germany. Sample: 135 of 244 identified service institutions took part in the evaluation. Measurements: This evaluation included changes in institutions' operating hours as well as capacity for homeless people. Service institutions described changes in guests' characteristics, moods, and mental burden. Finally, equipment including face masks, coveralls, and gloves was investigated. In addition, the study examined how the cooperation with the health authorities works. Results: Institutions reduced their operating hours and capacity for guests (62.4%). Increased costs, which they had to cover themselves, were reported by 70.9% of institutions. Institutions reported, that guests showed more symptoms of aggression (15%), anxiety (25%), and desperation (32%) and fewer signs of being relaxed (75%). The institutions reported room for improvement in PPE supplies and collaboration with health authorities. Conclusions: Services are limited for a vulnerable population, which shows changes in moods and mental health. Health authorities are not sufficiently engaged to take over the role of institutions in caring for homeless people. In the future, in‐depth investigation to improve this is necessary. [ABSTRACT FROM AUTHOR]

Aim: To compare recent compliance cost estimates by nurses of German nursing homes who employ the new documentation approach structural model with those who use traditional documentation frameworks. Design: A cross‐sectional survey. Methods: For each documentation approach, five sub‐processes were surveyed employing standard activities. The postal and online surveys were based on the same self‐administered questionnaire. The measures addressed time investments and further costs to carry out the components of nursing documentation. Data were collected from a convenience sample of nurses (n = 264) from German nursing homes between October 2018 and June 2019. Results: The analysed sub‐processes consume between 26 min and 8 hr per fulfilment. For users of the structural model, collecting information on a new admission is the costliest part of the documentation, at €90 per case. For users of other documentation approaches, care planning requires the most expensive effort, at €130 per case. [ABSTRACT FROM AUTHOR]

Background In responding to Covid-19, governments have tried to balance protecting health while minimizing gross domestic product (GDP) losses. We compare health-related net benefit (HRNB) and GDP losses associated with government responses of the UK, Ireland, Germany, Spain and Sweden from UK healthcare payer perspective. Methods We compared observed cases, hospitalizations and deaths under 'mitigation' to modelled events under 'no mitigation' to 20 July 2020. We thus calculated healthcare costs, quality adjusted life years (QALYs), and HRNB at £20,000/QALY saved by each country. On per population (i.e. per capita) basis, we compared HRNB with forecast reductions in 2020 GDP growth (overall or compared with Sweden as minimal mitigation country) and qualitatively and quantitatively described government responses. Results The UK saved 3.17 (0.32–3.65) million QALYs, £33 (8–38) billion healthcare costs and £1416 (220–1637) HRNB per capita at £20,000/QALY. Per capita, this is comparable to £1455 GDP loss using Sweden as comparator and offsets 46.1 (7.1–53.2)% of total £3075 GDP loss. Germany, Spain, and Sweden had greater HRNB per capita. These also offset a greater percentage of total GDP losses per capita. Ireland fared worst on both measures. Countries with more mask wearing, testing, and population susceptibility had better outcomes. Highest stringency responses did not appear to have best outcomes. Conclusions Our exploratory analysis indicates the benefit of government Covid-19 responses may outweigh their economic costs. The extent that HRNB offset economic losses appears to relate to population characteristics, testing levels, and mask wearing, rather than response stringency. [ABSTRACT FROM AUTHOR]