Abstract
Background: Hospital infrastructures account for a significant portion of healthcare expenditures, yet the factors driving facility management costs (FMCs) remain underexplored, particularly in the Italian context. This study aims to analyze FMCs in hospitals, focusing on utility and maintenance expenses, while providing benchmarking values to support decision making. Methods: This study employed a mixed-methods approach, integrating a literature review, financial data analysis, and a case study of 27 hospital facilities in Lombardy. Data on utility and maintenance costs were collected from financial statements and supplemented with targeted questionnaires to enhance precision. Descriptive statistics and parametric cost indicators (e.g., EUR/sqm, EUR/bed) were analyzed to identify trends and disparities. Results: FMC increased by an average of 32.90% between 2019 and 2022, with utility expenses constituting 77.45% of total costs and maintenance accounting for 22.45%. Utility costs rose significantly (37.34%), driven by energy and cleaning services, while maintenance costs grew more moderately (18.66%). Cost variability was evident across hospital typologies, with Basic Healthcare Centers averaging 122.86 EUR/sqm compared to 232.66 EUR/sqm for Level II Emergency Hospitals. Conclusions: This study highlights significant variability in FMCs across Italian hospitals and underscores the need for benchmarking to optimize resource allocation. Future research should expand the dataset, incorporating extraordinary maintenance costs, and examine management models to enhance cost efficiency. These findings provide actionable insights for policymakers and healthcare administrators to improve hospital infrastructure sustainability and efficiency.