Which will survive? The $150 billion capital question.

There are many misconceptions and commonly held "truisms" that cloud our understanding of hospital capital formation. In this attempt to clarify the issues related to hospital capital formation, three arguments are developed: 1) There are significant and frequently overlooked operating costs associated with capital investment projects, which can contribute significantly to hospital cost inflation. 2) The demand for hospital replacement, renovation and modernization is real but overstated. 3) Many hospitals will be unable to gain access to the capital market because of the populations they serve and their locations. It is argued that a coherent, targeted private and public sector policy on hospital capital formation is needed that addresses these points.