Rapid socio-economic evaluation of hospital construction projects based on counterfactual theory: the regional...

The assessment of hospital construction projects has evolved from limited financial and operational appraisals to comprehensive socio-economic evaluations. However, the application of socio-economic evaluation remains constrained by methodological and data limitations, particularly in remote and developing regions. A pressing challenge is to develop an accessible framework capable of overcoming these barriers, thereby facilitating rapid socio-economic evaluations that provide actionable insights for hospital administrators, investors and policymakers.

Hospital S was analyzed as a regional case study. Socio-economic and healthcare indicators (population, GDP per capita, health expenditure, beds, physicians, nurses) were obtained from local and supplemented national or international sources. A counterfactual framework was applied. Under the counterfactual scenario, no hospital construction was assumed and Disability-Adjusted Life Years (DALYs) and covariates were projected using the grey model. Under the factual scenario, hospital effects were incorporated through a pathway linking hospital construction to changes in indicators and subsequently to DALYs. DALYs were modelled using a log-linear multiple regression. Estimated coefficients were applied to translate changes in indicators into DALY differences between scenarios. The difference in DALYs was interpreted as disease burden averted and monetized using standard health economic thresholds to estimate socio-economic benefits.

By comparing outcomes under simulated counterfactual and factual scenarios, the new hospital would be projected to avert an average of 2216 DALYs annually, with a total of 24,374 DALYs averted across the entire project lifecycle. When varying the threshold settings, our analysis indicated that the new hospital would generate socio-economic benefits ranging from USD 29.5 million to USD 2.1 billion over its lifecycle.

This study proposes a practical and adaptable framework based on counterfactual theory for the rapid socio-economic evaluation of hospital construction projects from a regional perspective. The framework enables estimation of DALYs differences between factual and counterfactual scenarios and the corresponding socio-economic benefits under data-limited conditions. It is intended as a flexible analytical approach that can be adjusted according to context, data availability, and policy objectives, and may support evidence-based regional health planning and resource allocation.