Capital investment in public hospitals

Capital investment is a major concern for public hospitals. Relative to operating expenditures, it has been almost constant for 40 years, despite great changes in technology and patient throughputs. Research studies during the last decade suggest that over that time almost all investment has been on simply replacing existing assets. Per person, the total capital stock has actually declined. However most replacement outlays are predictable. Although major building outlays may still need some central supervision, equipment replacement can be projected with enough confidence to fund it through operating grants. Using data from several surveys, some capital-weighted DRGs have been developed and a funding system suggested.