# Economic and Environmental Impact of Energy Saving in Healthcare Buildings
## 4 Discussion  
The above results show that it is possible to save a large amount of energy in healthcare buildings in Spain. The application of efficient energy saving techniques would decrease the global energy intensity and harmful gas emissions into the atmosphere.  
In the healthcare sector there are buildings that consume great quantities of energy, so the energy management in healthcare centres will not only help to find a solution to reduce the energy intensity if not to also benefit the Spanish Health System, then economic reasons can be used in improving the medical attention of patients.  
Several energy saving measures have been found to be easily implemented without the need of investment, including an efficient management of the buildings and improvement of the electricity contract conditions. Therefore, they should be implemented immediately.  
For those energy measures that require an investment, finance viability and payback time must be taken into account. On the other hand, since LEDs are more efficient lighting systems and require a shorter payback time, they should be considered as well.  
Local subsidies are also interesting in order to introduce saving measures, particularly those related to renewable energy in buildings; the implementation of renewable energies has proved to be an appropriate strategy in order to reduce gas emissions into the atmosphere. However, at present, Spain does not offer the possibility to incorporate the surplus energy into to the public grid. Therefore, it is necessary to design these facilities with a self-consumption purpose, based on their annual operative period.  
Building design, efficient thermal insulation, and adequate sizing of buildings are key factors to keep in mind in future healthcare construction projects. These measures, thus, guarantee the well-being and satisfaction of the staff, patients, and managers.  
The energy system of a healthcare building is very complex and must strictly respect the regulations. The indoor climatic conditions, ventilation, and lighting level must be determined by medical activities [48]. Specific measures to improve the energy efficiency of a particular building should consider climatic and local conditions, the indoor climate environment, and amortization in terms of both economic and environmental aspects.  
Healthcare engineering plays a role of growing importance in almost every aspect of healthcare, and it will also be a major factor that advances healthcare [49]. Healthcare engineering professionals will face major challenges associated with issues, such as the continued rise in healthcare costs, the quality and safety of healthcare, management of common diseases, and the impact of high technology (biomedical, information, etc.).  
The results of this study are extrapolated to similar buildings with limitations due to the wide variety of healthcare building designs mainly based on architectural conception, climate conditions, and interior facilities. Future developments must focus on: (i) the development of healthcare infrastructures that use renewable energies; (ii) implementation of Healthcare 4.0 technologies; and (iii) making progress towards smart communities. Additionally, a reference set of indicators must be produced in order to evaluate energy consumption in a given healthcare building. In this manner, saving and efficiency energy policies could be implemented in the sector.  
\begin{table}
\begin{tabular}{c c c c} \hline \hline
**Impact** & **kWh/m2** & **Payback** & **\(\boldsymbol{\xi}\)/m2** \\ \hline \(<\)5000 m2 no beds & 0.30 & 4.00 & 0.05 \\ \(\geq\)5000 m2 with beds & 0.24 & 4.00 & 0.04 \\ \hline \hline \end{tabular}
\end{table}
Table 1: Potential of energy saving derived from optimal sizing of buildings.