In an era of U.S. energy abundance, the persistently high energy bills paid by low-income households is troubling. After decades of weatherization and bill-payment programs, low-income households still spend a higher percent of their income on electricity and gas bills than any other income group. Their energy burden is not declining, and it remains persistently high in particular geographies such as the South, rural America, and minority communities.

This paper aims to review the state of the art technologies for the energy efficiency within the hospitals sector. Hospitals are liable for an unstable amount of energy demand and joint emissions, because of their 24/7 nature of operation and hence resulting larger energy consumption than a typical commercial building. Additionally, they need high quality and warranted supplies of electricity. Due to increased energy demand and therefore the depletion of existing fossil fuel based sources, it is required to use the energy more efficient.

The economics of energy efficiency programmes have been subject to considerable academic debate lasting well over three decades now. In this paper, we contribute to this debate by reviewing the costs and benefits of a specific type of policy+ instrument that recently gained significant traction in Europe – Energy Efficiency Obligations - EEOs. Following the introduction of the EU Energy Efficiency Directive in 2012 the number of EEOs in Europe has grown from five schemes to now 16 EEOs in operation or planned across the EU.