[Hospital cost levels before and after investments in buildings]

Investments in hospital buildings in Norway are partly based on expectations of higher cost-efficiency. Health authorities are expected to treat patients at a lower cost than before the investment, whereby the savings can be used to cover capital costs. The purpose of our analysis is to verify whether this expectation is met.

Data on operating costs and DRG points for all health authorities were obtained from SAMDATA for the specialist health service for the period 1999-2023. The analyses were conducted as two-way analysis of variance (ANOVA), with the logarithm of hospital cost levels as the dependent variable. The period from 1999 to one year before implementation of the investment was used as the reference period.

Investments in the building stock were associated with short-term cost increases. The cost increases began the year before the investments were implemented and were 4.9 % (95 % confidence interval (CI) 0.7 to 9.0) above the cost level in the reference period in the year after implementation. From and including year four after the investment, the average cost level had returned to the reference level. Sensitivity analyses indicated that in projects where the entire building stock was renewed, there were no statistically significant changes in cost levels during the first three years after implementation. However, from year four onward, there was a significantly reduced cost level of -4.4 % (95 % CI -7.9 to -1.0).

Expectations of cost-efficiency were not achieved at the group level for investments in building stock carried out in the period 2003-2023. This raises questions about how realistic the regional health authorities' investment calculations are.