Significant Economies Of Scale Research Articles

From biogas to biomethane: Comparison of sustainable scenarios for upgrading plant location based on greenhouse gas emissions and cost assessments

Addressing the global energy crisis and achieving sustainable development goals (SDGs) necessitates shifting towards renewable energy sources, with biomethane emerging as a viable alternative. This study evaluated three scenarios for biomethane production from biogas: localized upgrading for biofuel use, district upgrading for biofuel use, and district upgrading with grid injection. By utilizing economic assessments and spatial and network analysis, the optimal locations for upgrading plants were identified to minimize transportation costs and GHG emissions (CO2 equivalents). Results indicate that Scenario 1 achieves the lowest emissions and operating costs (41 MEUR), while Scenarios 2 and 3, despite higher initial investments (152–173 MEUR), offer significant economies of scale (1187–1321 MEUR) and substantial annual production capacities (8.8 × 106 Sm³ of biomethane). Comparative and sensitivity analyses show renewable energy sources reduce GHG emissions by up to 83.7% and significantly lower operating costs. This research underscores the critical role of strategic planning and renewable energy integration in optimizing the biomethane value chain for environmental sustainability and economic viability while also emphasizing the need for further research to refine these findings.

Are agroecological cooperative supermarkets an alternative for scaling sustainable food?

The paper attempts to investigate the capacity of agroecological cooperative supermarkets in Spain to promote scaling of food products by means of a double perspective. We first employ a vertical scaling approach to analyze the issues affecting the governance and collective organization of the Cooperative Supermarket Network (CSN), set up in May 2022 and comprising eleven Spanish supermarkets. Secondly, we employ a perspective of horizontal scaling to investigate the potential for increased numbers of members, as well as the geographic and sociodemographic variables at play which limit the abovementioned scaling: to this end we use the case study of the cooperative supermarket La Osa, opened in Madrid in December 2020. We adopt a methodology based on participatory action research throughout the years 2022 and 2023, in which the research team was involved in the real processes of creation and development of the CSN or of La Osa. The study confirms the hypothesis that agroecological cooperative supermarkets constitute a formula for efficient retail distribution for scaling sustainable food in Spain. As opposed to the first-generation options for responsible consumption, these supermarkets appear to contribute to generating significant economies of scale and scope. In terms of vertical scaling, joint provision of services, as well as the gaining of political influence in society, constitute the main advantages in relation to the functioning of the CSN. While the recruitment of new members has heretofore been considered a priority in horizontal scaling, particular emphasis should also be placed on loyalty strategies targeting existing members.

Childhood dementia: the collective impact and opportunities for intervention

AbstractBackgroundChildhood dementia is a devastating and under‐recognised group of conditions with a high level of unmet need. Typically monogenic in origin, this collective of neurodegenerative conditions are defined by a progressive impairment of neurocognitive function, presenting in infancy, childhood or adolescence.MethodWe undertook a scoping review and burden of illness study to understand the spectrum of childhood dementia conditions and their impact. A literature review identified conditions that met the case definition and an expert clinical working group reviewed and ratified inclusion. Epidemiological data were extracted from published literature and collective incidence, prevalence and life expectancy were modelled.ResultOver 140 individual genetic conditions were identified that can be consistently defined as childhood dementia with the largest proportion of births belonging to the lysosomal disease and mitochondrial disease categories. Collectively the incidence is surprisingly high at 1 in 2,900 births and the life expectancy is low, with most affected children not surviving into adulthood. A relational database of the childhood dementia disorders has been created and will be continually updated as new disorders are identified (https://knowledgebase.childhooddementia.org/).ConclusionThis scoping review highlights the importance of grouping these conditions as a phenotypic syndrome, rather than individually rare diseases, in keeping with the approach to adult dementia. Opportunities exist to address overlapping disease mechanisms and utilise therapeutic platforms for multiple childhood dementia conditions to tap into significant economies of scale. Collaboration with adult dementia researchers on common disease attributes is also expected to be mutually beneficial.By unifying these conditions, we have highlighted the many unmet needs of this significantly disadvantaged group of children and young people and the data presented here will enable advocacy for systemic change in treatment, care, and support for them and their families.

(Invited) Electrolyser Manufacturing Scale-up Versus Design Development for Meeting Green H2 Targets

Cummins-Hydrogenics pioneered our MW-scale PEM electrolysis cell stack architecture in 2012 and has built and operated multiple sites since, including the 20 MW Bécancour facility for Air Liquide from 2020. Lessons learned from these projects provide a springboard for large-scale manufacturing and deployment of PEM electrolysers worldwide and Cummins has announced GW-scale manufacturing deployment in Europe, N America and Asia. This is required to meet the growing global demand for PEM electrolysers, which derives from the targets and subsidies for green hydrogen production announced by many governments.Concurrent to this manufacturing scale-up, significant work on cost reduction and technology advancement is ongoing resulting in anticipated cost decreases from catalyst loading (Ir<150g/MW), efficiency improvements (<46 kWh/kg) and higher current density, all of which need to be achieved for commercial viability. Driving down the Ir-loading of PEM electrolysers while increasing current densities will remain the primary driver of CapEx reductions in the short to medium term but the deployment of large-scale manufacturing also allows for significant economies of scale. Recycling and regeneration of used components will also become a larger issue and new processes need to be implemented for each stack component.Moving from a project-based design methodology to design for volume manufacturing, all while maintaining the fast pace of technology development, makes for significant challenges and can lead to processing waste and inefficiencies. Rigorous testing and validation protocols are needed across the industry in order to successfully scale-up while implementing technology improvements necessary to meet TCO targets. This talk will focus on the juxtaposition of these challenges and ways to mitigate future risks.

Co-designing a Sexual Health App With Immigrant Adolescents: Protocol for a Qualitative Community-Based Participatory Action Research Study

Canada is one of the world's most ethnically diverse countries, with over 7 million individuals out of a population of 38 million being born in a foreign country. Immigrant adolescents (aged 10 to 19 years) make up a substantial proportion of newcomers to Canada. Religious and cultural practices can influence adolescents' sexual attitudes and behaviors, as well as the uptake of sexual and reproductive health (SRH) services among this population. Adolescence is a time to establish lifelong healthy behaviors. Research indicates an alarming gap in adolescents' SRH knowledge, yet there is limited research on the SRH needs of immigrant adolescents in Canada. The purpose of this study is to actively engage with immigrant adolescents to develop, implement, and evaluate a mobile health (mHealth) intervention (ie, mobile app). The interactive mobile app will aim to deliver accurate and evidence-based SRH information to adolescents. We will use community-based participatory action research to guide our study. This research project will be conducted in 4 stages based on user-centered co-design principles. In Stage 1 (Empathize), we will recruit and convene 3 adolescent advisory groups in Edmonton, Toronto, and Vancouver. Members will be engaged as coresearchers and receive training in qualitative and quantitative methodologies, sexual health, and the social determinants of health. In Stage 2 (Define and Ideate), we will explore SRH information and service needs through focus group discussions with immigrant adolescents. In Stage 3 (Prototype), we will collaborate with mobile developers to build and iteratively design the app with support from the adolescent advisory groups. Finally, in Stage 4 (Test), we will return to focus group settings to share the app prototype, gather feedback on usability, and refine and release the app. Recruitment and data collection will be completed by February 2023, and mobile app development will begin in March 2023. The mHealth app will be our core output and is expected to be released in the spring of 2024. Our study will advance the limited knowledge base on SRH and the information needs of immigrant adolescents in Canada as well as the science underpinning participatory action research methods with immigrant adolescents. This study will address gaps by exploring SRH priorities, health information needs, and innovative strategies to improve the SRH of immigrant adolescents. Engaging adolescents throughout the study will increase their involvement in SRH care decision-making, expand efficiencies in SRH care utilization, and ultimately improve adolescents' SRH outcomes. The app we develop will be transferable to all adolescent groups, is scalable in international contexts, and simultaneously leverages significant economies of scale. PRR1-10.2196/45389.

Climate and the productive structure of the urban water industry

ABSTRACT Climate is likely to affect the productive structure of urban water supply systems through its effects on reservoirs’ volume, water quality, and consumption. This paper investigates these effects by analyzing the role of temperature and rainfall in water utilities’ costs with a multiple-equation cost function model and a rich firm-level database that describes the operations of 3845 firms from 2008 to 2018 in Brazil. Results reveal the presence of causal effects of rainfall and, in some cases, temperature on costs, with small firms being more vulnerable to cope with adverse (dry) weather. Results also suggest significant economies of scale and density yet to be realized by the industry. Considering the highly fragmented Brazilian urban water industry, the findings show potentially large cost savings associated with an eventual regional consolidation of operations, particularly under the realization of climate change scenarios that show hotter and drier weather conditions.

The costs of and economies of scale in supporting students from low socioeconomic status backgrounds in Australian higher education

ABSTRACT This study examined the costs of supporting Australian university students from different socioeconomic status (SES) backgrounds and whether there are economies of scale. The mixed-methods research in 2018 and 2019 found that substantially higher costs applied for supporting students from low SES backgrounds. These were explained by the costs inherent in: increasing aspiration and capital prior to university; academic, personal and financial support provided while studying; establishing, maintaining and appropriately staffing multiple university campuses, particularly in highly disadvantaged areas; and supporting highly complex student needs. It was found that there are significant economies of scale where there are between 517 and 2584 fulltime undergraduate students from low SES backgrounds at a university. It follows that the average cost of supporting these students can be reduced if enrolment numbers are within this range, subject to caveats around the costs identified. Potential policy implications include: a redistribution of funding based on need; shifting emphasis from activity-based to mission-directed costing; applying the principles of ‘cost compensation’; and conceptualising funding support for students from low SES backgrounds as a transformational investment that can improve outcomes for individuals, communities and society, rather than as a cost.

Planning a maritime supply chain for liquefied natural gas under uncertainty

This paper studies the design of a mid-scale maritime supply chain for distribution of liquefied natural gas (LNG) from overseas sourcing locations, via a storage located at the coast, before transporting the LNG on land to industrial customers. The case company has signed contracts with a number of initial customers and expect that there will be more customers and increased demand in the years to come. However, it is currently uncertain whether and when new contracts will be signed. To capture this uncertainty with regard to which and how many future customers there will be, which directly affects the demand, we propose a multi-stage stochastic programming model, which maximizes the expected profits of the supply chain. The model aims at aiding decisions concerning the import of LNG, investments in floating storage units and customer distribution systems, and it has been applied on a real case study for distributing LNG to customers in a Brazilian state. It is shown that explicitly considering uncertainty in the modeling of this problem is very important, with a Value of Stochastic Solution of 13.2%, and that there are significant economies of scale in this supply chain. Most importantly, the multi-stage stochastic programming model and the analysis presented in this paper provided valuable decision support and managerial insights for the case company in its process of setting up the LNG supply chain.

Controversial Results of the Reform of the Russian Electric Power Industry in 1986–2008

The article discusses the ambiguous results of the reform of the Russian electric power industry. Some of the intended goals of the reform have been achieved, while others have not yet been achieved, and the reform should be continued. Although more than 13 years have passed since the final stage of the reform, there is no agreement in the literature on many key issues characterizing the reform: an explanation of the reasons and factors that influenced the decision to reform the Russian electric power industry, the goals of the reform, the type of the reform model, the validity of its adaptation to the real Russian conditions and institutions that had developed by the beginning of the reform, the results of the reform and their value for society. It was found that contradictory results of the reform are caused by both objective and subjective factors. Along with obvious successes (e.g., denationalization of the industry) and obvious failures (including failure to create retail electricity markets) many results (elimination of vertical integration, level of competition on wholesale electricity markets, etc.) are not observable and have not received a clear and unambiguous assessment of their usefulness to society. Studies using modern economic theory and economic-mathematical modeling were required. No statistically significant economies of scale in electricity generation have been found in large companies generating electricity. Thus, the use of competition as a mechanism to coordinate the interests of society, producers and consumers of electricity and the creation of a wholesale electricity market is scientifically justified. Unification of small producers for their withdrawal to the wholesale electricity market should be accompanied by an economic analysis of the cost function of the united company. It is shown that in the short term the wholesale electricity market created in the first and second price zones is close to competitive, but in the long term there is a threat: this market may become uncompetitive.

Determinants on ETF Launching Decisions

This paper studies the decision by an asset manager to launch an exchange-traded fund (ETF). Fund families focus on both revenue generation and cost reduction when making launching decisions, with new ETF launches being driven more by investor demand than past performance. The ETF industry exhibits significant economies of scale and scope, allowing larger families to benefit from specialization while giving smaller families pressure to expand their product line. Competitors tend to follow the asset allocation decisions of the three largest ETF providers, unless when it comes to less liquid or highly concentrated objective markets. Finally, a time-to-event analysis shows that an ETF survives for longer if launched by fund families with larger size and higher fees, and whose initiation is not driven by excessive flows into the family.

The impact of technological capability on MSME innovation: a case study of Vietnam

ABSTRACT This paper explores the dynamic complementary interaction between investment in technological capability and investment in specific innovation projects based on a decision model of innovation, using Vietnamese MSME data. The empirical results show that firm size, technological capability and current specific R&D investment have a positive impact on innovation. Firm age was positive but not significant, implying that conscious technological effort may be more important for innovation than passive learning by doing. The combination of significant economies of scale and technological capability imply that government assistance for firms with low technological capability maybe important, but government assistance is shown to be either insufficient or ineffective. Results from this paper suggest that government policy aimed at facilitating increases in firm size and providing technical extension services would be more constructive than merely providing R&D subsidies to MSMEs.

Open Access, Interoperability, and the DTCC's Unexpected Path to Monopoly

In markets with significant scale economies and network effects, scholars and policymakers often tout open access and interoperability requirements as superior to both regulated monopoly and the break-up of dominant firms. In theory, by compelling firms to coordinate to develop common infrastructure, regulators can use these requirements to replicate scale and network economies without leaving markets vulnerable to monopoly power. Examples of successful coordination include the provision of electricity, intermodal transportation, and credit card networks. This Article analyzes the history of U.S. securities clearinghouses and depositories in order to offer a significant qualification to this received wisdom. This history demonstrates that open access and interoperability requirements can actually serve as instruments by which dominant firms obtain and entrench their monopoly power. Specifically, by imposing high fixed costs to connect to common infrastructure, allowing dominant firms to dictate the direction and pace of innovation and investment, and reducing the scope for product differentiation, these requirements can prevent smaller firms from competing with their larger rivals. In these ways, open access and interoperability can actually exacerbate the very problems that they were designed to address. Our analysis helps explain why important components of our financial infrastructure have become too-big-to-fail. It also helps explain why, despite their highly concentrated structure, U.S. securities clearing and depository markets have still been characterized by relatively high levels of innovation and investment. More broadly, our analysis suggests that coordination requirements will only constrain market power where the costs of building, maintaining, and connecting to common infrastructure are allocated in a way that does not discriminate against smaller firms, and where larger firms are not able to dictate decisions about innovation and investment. Where this is not possible, interoperability and open access are unlikely to forestall monopoly control, even though they may still improve market efficiency by exposing incumbents to the threat of new entry.

The Potential of Agricultural Biogas Production in Ukraine—Impact on GHG Emissions and Energy Production

Renewable energy production is gaining importance in the context of global climate changes. However, in some countries other aspects increasing the role of renewable energy production are also present. Such a country is Ukraine, which is not self-sufficient in energy supply and whose dependency on poorly diversified import of energy carriers regularly leads to political tensions and has socio-economic implications. Production of agricultural biogas seems to be a way to both slow down climatic changes and increase energy self-sufficiency by replacing or complementing conventional sources of energy. One of the most substantial barriers to agricultural biogas production is the low level of agricultural concentration and significant economies of scale in constructing biogas plants. The aim of the paper was thus to assess the potential of agricultural biogas production in Ukraine, including its impact on energy self-sufficiency, mitigation of greenhouse gas (GHG) emissions and the economic performance of biogas plants. The results show that due to the prevailing fragmentation of farms, most manure cannot be processed in an economically viable way. However, in some regions utilization of technically available manure for agricultural biogas production could cover up to 11% of natural gas or up to 19% of electricity demand. While the theoretical potential for reducing greenhouse gas emissions could reach 5% to 6.14%, the achievable technical potential varies between 2.3% and 2.8% of total emissions. The economic performance of agricultural biogas plants correlates closely with their size and bioenergy generation potential.

The provision of mobility as a service with autonomous vehicles. The necessity of regulatory schemes for a natural monopoly

This paper addresses the provision of Mobility-as-a-Service (MaaS) once autonomous vehicles become available, putting special emphasis on the cost structures of MaaS-providers. The results show the existence of significant economies of scale and, therefore, the market is likely to become a natural monopoly. The difference with the current situation is explained by the absence of a driver and it provides an explanation for the aggressive and deficitary expansion strategies of current TNC providers. Furthermore, given that natural monopolies require regulation in order to avoid losses of social welfare, the paper considers five different regulation scenarios. For this purpose, we also take into account the existence of negative and positive externalities as well as other issues specific to the provision of MaaS, such as spatio-temporal considerations and complementarity/competition with other transport modes.

Farmer Behavior Under Groundwater Management Scenarios: Implications for Groundwater Conservation in the Mississippi Alluvial Plain

Concern about sustained availability of fresh groundwater for agricultural use in the Mississippi Alluvial Plain (MAP) mounts as groundwater levels decline. We evaluate the elasticities of demand for groundwater and other agricultural inputs, as well as the overall and output-specific economies of scale for four major irrigated commodities (rice, corn, soybeans, and cotton) in the MAP region. Additionally, we investigate the impacts of two groundwater management policy scenarios, including increasing pumping cost and groundwater use restrictions, on irrigation behavior. The results show price elasticity of demand for groundwater to be [Formula: see text], indicating that it is inelastic, and an increased cost of pumping will not significantly decrease the relative demand for groundwater in the region. Even with policy scenarios that either increase the costs of pumping significantly or restrict groundwater use in the region, groundwater demand still appears to be inelastic. We also document significant overall economies of scale in the region. Our findings have implications for potential policy options aimed at reducing groundwater use. Efficient management practices are important to increase aquifer recharge, and considering human behavior via economic analysis will improve projections of groundwater availability in the MAP region.

Supply Chain Uncertainties of Small-Scale Coffee Husk-Biochar Production for Activated Carbon in Vietnam

Between 2014 and 2019, an innovative small-pyrolysis system (the PPV300) using agrowaste as feedstock was transferred and adapted from Switzerland to Vietnam by a United Nations Industrial Development Organization (UNIDO) project. The coffee husk resulting from the processing of coffee beans is usually disposed of in Vietnam or burned inefficiently to dry coffee beans. Small-scale pyrolysis of coffee husk using the PPV300 avoids smoke emissions and local air pollution while providing an energy source for coffee drying and biochar as a by-product. This paper investigates the uncertainties in the “coffee husk to activated carbon” supply chain in Vietnam and discusses the pros and cons of different supply chain setups using a framework derived by Chopra and Meindl (2013). According to the analysis, a number of actors (an intermediary without previous direct involvement in the coffee supply chain, a coffee processor, or a hybrid between farm and processor), each with advantages and disadvantages, would be suitable from a supply chain perspective to attain an efficient strategy that would keep the price of the biochar low. However, in order to be attractive for one activated carbon producer, several PPV300 systems are needed to reach a significant economy of scale. Sufficient husk sourcing and storage capacity is also needed. If the purpose is simply to produce biochar for activated carbon, processors and intermediaries could consider a simpler and cheaper design than the PPV300. In conclusion, supply chain uncertainties and economic viability can be optimized when the PPV300 is used by coffee processors or intermediaries, who are able to make use of the co-products generated (biochar, heat, and wood vinegar). In addition to its financial viability, all of the other co-benefits of this technology should be taken into consideration (reduced smoke and environmental pollution, avoided health costs, greenhouse gas savings, etc.) for a proper assessment of its economic attractiveness.

Evaluation of integrated control of three dog transmitted zoonoses: Rabies, visceral leishmaniasis and cystic echinococcosis, in Morocco

The present study is a component of a major European research project, ICONZ (Integrated Control of Neglected Zoonoses). The objective of this component was to implement, and then evaluate an Integrated Control Intervention (ICI) against three dog transmitted zoonoses, namely rabies, visceral leishmaniasis, and cystic echinococcosis. This was undertaken in Sidi Kacem Province (northwestern Morocco) where 22 control and 22 treated douars (villages) were randomly allocated to two control and one evaluation interventions over a period of 13 months. Across the 44 douars, an overall total of 6922 dogs were registered, 4519 were vaccinated against rabies, and 2885 persons attended the complementary health education campaigns; whereas, within the 22 treated douars, 466 dogs received anti-sandfly collars (deltamethrin-impregnated) and 2487 were dewormed (praziquantel). Evaluation of the ICI, revealed that (i) a canine rabies vaccination coverage of 65.0% was achieved, (ii) the use of deltamethrin-impregnated collars for dogs provided highly significant protection (p = 0.01) against leishmaniasis infection of more than 44%, and up to 100% for dogs that had kept the collar until the end of the intervention, (iii) despite a non-significant difference (p>0.05), dog-deworming with praziquantel yielded a reduction in the rate of Echinococcus granulosus infection, and (iv) health education was successful in improving respondents’ knowledge; However, the target communities remained unconvinced of the necessity of changing some of their risky behaviours. Lastly, the estimated total cost of the global intervention, including its research components, was US$ 143,050, of which 67% was for disease control work with clear evidence of significant economies of scale due to targeting three diseases together. It appears from this study that the integrated control approach against the three zoonoses was effective on both economic and logistical levels.

Scale economies and total factor productivity growth on poultry egg farms in Benin: a stochastic frontier approach

The study examines economies of scale and sources of total factor productivity growth on poultry farms producing table eggs in Benin Republic. We use panel data on commercial poultry farms from 2010 to 2018, and the flexible translog production functions to estimate a stochastic frontier and economies of scale. The results showed that there were significant economies of scale to be exploited, and the average productivity growth rate was decreasing of 5.09% over the study period. This deterioration was mainly because of the decline of technical efficiency growth rate (2.16%) and technology growth rate (2.67%). Although the returns to scale (1.31) were increasing, their effects on productivity during the study period were negative (−0.74%). As implications, policy makers may encourage the increasing of the “size” of poultry farms and act on the sources of productivity growth identified in this study to increase the productivity of commercial poultry farms to meet the demand of table egg in Benin.

Competition and market structure in the dental industry.

We use Survey of Dental Practice data from 1983 to 2012 to examine market power of dentists and hygienists in private practice. Our findings are consistent with a dental market wherein practices use hygienist services as a "loss leader" in order to steer patients into more lucrative dental services, which exhibit the ability to markup price above marginal cost. Both dental care exhibits an elasticity of demand of roughly - 0.2, while hygienist care exhibits and elasticity of demand of nearly - 0.6. Another theme that emerged from our findings is the evidence for significant economies of scale in the dental market. The overall returns to scale parameter of 2.1 suggests significant increasing returns to scale are available to the typical dental practice. Given that the typical practice has 1.5 dentists, the finding is not surprising. While returns to scale diminishes with visit volume, the largest quartile of practices still has meaningful increasing returns to scale of roughly 1.75.

Measuring and optimising the efficiency of community hospital inpatient care for older people: the MoCHA mixed-methods study

BackgroundCommunity hospitals are small hospitals providing local inpatient and outpatient services. National surveys report that inpatient rehabilitation for older people is a core function but there are large differences in key performance measures. We have investigated these variations in community hospital ward performance.Objectives(1) To measure the relative performance of community hospital wards (studies 1 and 2); (2) to identify characteristics of community hospital wards that optimise performance (studies 1 and 3); (3) to develop a web-based interactive toolkit that supports operational changes to optimise ward performance (study 4); (4) to investigate the impact of community hospital wards on secondary care use (study 5); and (5) to investigate associations between short-term community (intermediate care) services and secondary care utilisation (study 5).MethodsStudy 1 – we used national data to conduct econometric estimations using stochastic frontier analysis in which a cost function was modelled using significant predictors of community hospital ward costs. Study 2 – a national postal survey was developed to collect data from a larger sample of community hospitals. Study 3 – three ethnographic case studies were performed to provide insight into less tangible aspects of community hospital ward care. Study 4 – a web-based interactive toolkit was developed by integrating the econometrics (study 1) and case study (study 3) findings. Study 5 – regression analyses were conducted using data from the Atlas of Variation Map 61 (rate of emergency admissions to hospital for people aged ≥ 75 years with a length of stay of &lt; 24 hours) and the National Audit of Intermediate Care.ResultsCommunity hospital ward efficiency is comparable with the NHS acute hospital sector (mean cost efficiency 0.83, range 0.72–0.92). The rank order of community hospital ward efficiencies was distinguished to facilitate learning across the sector. On average, if all community hospital wards were operating in line with the highest cost efficiency, savings of 17% (or £47M per year) could be achieved (price year 2013/14) for our sample of 101 wards. Significant economies of scale were found: a 1% rise in output was associated with an average 0.85% increase in costs. We were unable to obtain a larger community hospital sample because of the low response rate to our national survey. The case studies identified how rehabilitation was delivered through collaborative, interdisciplinary working; interprofessional communication; and meaningful patient and family engagement. We also developed insight into patients’ recovery trajectories and care transitions. The web-based interactive toolkit was established [http://mocha.nhsbenchmarking.nhs.uk/(accessed 9 September 2019)]. The crisis response team type of intermediate care, but not community hospitals, had a statistically significant negative association with emergency admissions.LimitationsThe econometric analyses were based on cross-sectional data and were also limited by missing data. The low response rate to our national survey means that we cannot extrapolate reliably from our community hospital sample.ConclusionsThe results suggest that significant community hospital ward savings may be realised by improving modifiable performance factors that might be augmented further by economies of scale.Future workHow less efficient hospitals might reduce costs and sustain quality requires further research.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 8, No. 1. See the NIHR Journals Library website for further project information.