'Theme Hospital' Was a Satire of the Terrible American Healthcare System

Sega announced a spiritual successor to Theme Hospital this week . The original game put players in control of a series of hospitals where the money comes hard and the diseases are hilarious. The new game is Two Points Hospital and it already seems like it’s ready to bring back the original’s strange sense of humor. Its trailer comes just months after developer Oxymoron Games announced Project Hospitalits own take on the sickness simulator.

But the original wasn’t just another 1990s sim game with wacky maladies such as slack-tongue. It was also a brutal teardown of the American healthcare system.

In 1997, British developer Bullfrog Productions released Theme Hospital on the PC and original PlayStation. It was a fun game that succeeded because of its charm and its dark humor. Its world isn’t one with a publicly funded National Health Service like in the UK, but a cold, profit-driven system where every dying patient is a potential source of income or a corpse to be examined for tech upgrades. Sound familiar?

To get myself in the mood for another round of managing hospitals full of patients suffering from Elvis impersonator syndrome, I picked up Theme Hospital on the digital storefront GOG. It runs OK through the DOSBox emulator, but the fan-made CorsixTH mod brings it into the the modern gaming era with higher resolutions, bug fixes, and a better save system. If you decide to revisit this one—and I think you should—then CorsixTH is a must.

It’s a sim game that seems easy at first, but grows difficult as the player learns to manage its competing expectations. Players are hospital managers—building facilities, hiring and firing doctors, and researching treatments to rare diseases. It’s not a sandbox sim where players build their dream hospital, but rather a series of scenarios where the player learns its systems and takes over different facilities.

As I replayed it, I quickly picked up on something that I hadn’t noticed 20 years ago when I was a tween— Theme Hospital is a teardown of US-style for-profit hospitals, which rake in tens of billions of dollars a year. In 2015 alone, America’s top seven hospitals earned a record $33.9 billion according to U.S. News & World Report.

Do well in the poor neighborhood and the Health Ministry— Theme Hospital’s version of the US Department of Health and Human Services—will send you to the rich neighborhood. To clear each scenario, a good hospital manager must cure a certain number of people, keep up the hospital’s reputation, make the facility worth a certain amount of cash, and hold a large sum of money in the bank. It’s a gameplay mechanic that mirrors America’s obsession with hospital ratings.

The first two are easy. If a player manages the hospital correctly and hires the right staff then the cures and reputation will come. Turning a profit is the real challenge and leads to fucked up choices. Theme Hospital is funny, but the wacky diseases such as gut rot and chronic nose hair are are a distraction from profit-driven tone is present right from the opening cutscene.

It depicts a hot shot doctor witnessing a helicopter crash, putting down his video game controller, tossing a nurse aside, and entering the operating room like a hero. Then the nurse pulls out the victim’s wallet, scans his card and learns he’s in credit default. The doctor, shocked, puts down his surgical chainsaw and the operating room dumps the freeloader into a pit.

The message is clear—if a patient doesn’t have the money for services, they’re gonna die. The message resonates in a modern America where lack of access to affordable healthcare kills people every year. According to a meta-study in the Annals of Internal Medicine, lack of proper insurance raises a person’s risk of death by almost 30 percent.

In Theme Hospital, being poor doesn’t mean you can’t be of use. Later on, an “automatic autopsy” machine becomes available and unscrupulous hospital manager can send sick patients to the machine to advance the cause of science. Those sick patients do die. It’s an autopsy after all, but the hospital’s tech tree gets a little boost and doesn’t loose cash treating a poor. Sure, the hospital’s reputation takes a hit if a living patient wanders down the wrong hall and sees the machine, but reputation is easier to regain than money.

Like a real hospital, there are endless issues to deal with. The hospital is too cold, needs more operating rooms, more soda machines, and—of course—better pay for the staff. None of these problems are really about better care for the sick, they’re about making sure the bottom line doesn’t erode. More heat costs more money and it’s often better to let people get a little cold. It incubates disease. People get thirsty, but why put in a water fountain when a soda machine generates income?

Doctors and nurses in the game want more cash constantly, but why bother retaining a good doctor when a young and inexperienced one is so much cheaper. It’s easier to hit those profit goals when you’re getting rid of complaining staff and moving poor patients to the incinerator. After a few hours in Theme Hospital’s world, I was cynically cutting back on the heat and lining the walls with soda machines. I didn’t feel good about myself.

Playing Theme Hospital in my 30s is much different than playing it as a teenager. Everyone I know in the US has a healthcare horror story. I’m 100 percent sure I have undiagnosed sleep apnea, but getting a sleep study done so I can have a CPAP machine has been a bureaucratic nightmare. But I have it easy, I know a woman with type 2 diabetes who moved to the Czech Republic because she couldn’t afford American healthcare costs.

Two Points Hospital is being developed by Gary Carr and Mark Webley, two of the people behind Theme Hospital. Hopefully, their new game manages remind us about this truth about healthcare that is so horrible you have to laugh, because that’s what made Theme Hospital tick.