Health Care Costs
Immediately after the clock changes to DST, an increase in health care costs and mortality is observed:
Health care costs increase (the loss is estimated at 4 million euros per 1 million citizens over a period of 4 days) [JiZi20];
Mortality increases due to a sudden increase in heart attacks (24% increase in daily heart attacks [SaSG14]) and car accidents (6% increase overall, given that locations further west in a time zone are more severely affected [FVWV20]).
The costs for the increased death rate due to the changeover to summer time are estimated at 0.44 million euros per 1 million citizens [JiZi20, Smit16]. For Germany this means a loss of around 37 million euros. However, the extent of the loss of human life must by no means be limited to an economic balance sheet.
Even more important than the temporary additional expenses due to the clock change in spring, however, are the health costs that are to be expected due to the long-term effects of a permanent DST. With DST, we experience serious health consequences [GiMa19 , HSTT16] , being one of them an increasing risk of cancer [Bori11a, Diem00, GXDZ17, VWVH18].
In order to estimate the influence of permanent DST on health costs, studies care available that compare health costs between regions east and west of time zone boundaries [GiMa19] .
As shown in Figure 1, sunrise and sunset to the east of the time zone border take place an hour later than west of the time zone border according to the local clock, although in reality both localities experience the same solar time. For example, on the east side of the border you would say that the sunrise occurs at 8 a.m. in clock time, while on the west side you see the sun rise at 7 a.m. in their clock time. This time offset in social time of one hour (meaning the differences between what both clocks register in the previous example) corresponds to the difference between standard time and DST. The people east of the time zone border live in permanent summer time compared to those west of the time zone border. A study that compares the health costs east and west of the time zone border with each other comes to the following conclusion: health expenditures in localities east of the time zone border (i.e. where there is a permanent DST compared to the west side) is at least 2.35 billion USD ($82 per capita) per year (around 2 billion euros) higher than in the districts west of the time zone border [GiMa19].
Figure 1: Local time of sunrise and sunset east and west of the time zone boundary. Source: [GiMa19]
If you add the $82 per capita per year overhead to the U.S. health care cost of $10,738 per capita in 2017 (according to the Center for Disease Control and Prevention - CDC), this equates to a 0.76% increase in health care spending by permanent DST (compared to a permanent standard time). At this point, however, it should be mentioned that the study cited by no means took into account the entire spectrum of health complications that result from DST. Expenditures for obesity, diabetes, heart attacks and heart diseases, strokes, as well as breast, prostate and colon cancer were considered. But, expenditures for mental illness, neurodegenerative diseases, autoimmune diseases or sleep disorders were not considered, although scientific studies confirm or indicate their increased probability of occurrence due to DST (see section "Health"). It is therefore to be expected that the actual increase in health costs will be even higher due to permanent summer time. Unfortunately, there is not yet a comprehensive estimate in which the costs of all known health problems caused by summer time are considered.
Based on the available data (2018) [Oec: 00, Thea00] and assuming similar effects as in the USA, this means for Germany: under permanent DST, the additional health costs would be around 2915.6 million euros higher than under a permanent standard time. If we consider that we spend 7 months in the summer time, the current costs are already around 1700.8 million euros.