# Economic and Environmental Impact of Energy Saving in Healthcare Buildings
## 1 Introduction  
As an important sector in developed countries, healthcare buildings play a major role in their economy because of the large quantities of energy they use. In particular, the public healthcare sector expense in Spain reached 670,635.7 million, which represented 6.5% of its Gross Domestics Product (GDP) in 2017, in which 4.71% belonged to the public sector (with about 108,000 beds) and 1.80% corresponded to the private sector (52,000 beds approximately) [1]. The public expenditure on health reached 61521 per inhabitant in Spain.  
In the last few years, the energy intensity in Spain has increased, while it has regularly been decreasing in most of the EU. While Spain is dependent on primary energy at about 80%, it only represents 50% on average in the EU [2]. For this reason, it has become urgent and necessary to establish efficiency measures in order to save energy in all the sectors of consumption, and particularly in hospitals [3].  
Madrid Energy Foundation (2010) indicated that the annual energy consumption in a small hospital reached 40,000 kWh, with an annual expense of 68400 [4].  
[PERSON] et al. (2012) reported that up to 10% of primary energy consumed could be save by implementing simple energy saving techniques. In order to do that, high-cost energy categories should be controlled and monitored [5].  
[PERSON] et al. (1994) quantified the potential global energy savings in 30 healthcare buildings in Hellas (Greece) by energy audits analysis. They concluded that up to 20% of energy could be saved [6]. [PERSON] et al. (2008) argued that depending on the building, energy consumption varied broadly. They proposed that a benchmark of 0.2 GJ/m\({}^{3}\) would be realistic [7].  
[PERSON] et al. (2011) demonstrated in a hospital in Belgium that it is possible to save up to 71% of the primary energy by using stored thermal energy in combination with a heat pump, instead of conventional gas-based boilers and water chillers [8]. [PERSON] et al. (2012) showed that a change in the occupancy patterns of a building with respect to the initial design settings might result in higher rates of energy consumption for lighting purposes, which could potentially represent up to 50% energy savings [9].  
[PERSON] et al. (2007) reported on the energy behaviour of different types of health service facilities within Argentinian Public Health Network, and assessed correlations between energy consumption rates and several related variables, including space, usage, infrastructure and equipment [10]. However, no specific energy saving measures were proposed.  
[PERSON] et al. (2010) worked in the Advanced Energy Design Guide, which aimed to save 30% in energy, as required by ANSI/ASHRAE/IESNA, applied to small hospitals and healthcare facilities. The guide provided user-friendly assistance and recommendations for the design and construction of buildings [11].  
[PERSON] et al. (2004) studied energy consumption indicators in hospitals in Brazil [12]. They found that the average ratio between thermal and electric loads was appropriate to use cogeneration systems. In addition, by analysing a non-optimized cogeneration system, they predicted substantial potential energy savings and CO\({}_{2}\) reduction.  
However, none of the above-mentioned authors either analysed or quantified any possible annual economic saving derived from optimizing and managing the energy needed in this type of building.  
The purpose of this article is to estimate the economic and environmental impacts of energy consumption derived from healthcare buildings and proposes several energy-saving options in the sector. The results of this study will be used to development a suitable tool both in the fields of project-management of new hospitals and cost-optimisation in existing healthcare buildings.