Indie Wonderland: Two Point Hospital

An interesting thing happened in the process of drafting this week’s review: An American friend told me that Bullfrog’s old Theme line of games, of which Theme Park and Theme Hospital are probably the most notable, never got quite as much traction in the States as they did in Europe. This was surprising to me, because I don’t think I knew anyone back then who was into games and didn’t play either of those two. I played both, and while Theme Park was the one I spent more time with, Theme Hospital is the game that stuck with me the most. I still occasionally hum some of its music. It stuck with me partially because it was one of the first business simulation-esque games I ever played, much moreso than Theme Park (which I played mostly as an excuse to build bad rollercoasters), and partially because I don’t remember seeing anything else like it since. Theme Park had sequels, competitors, spinoffs, Planet Coaster a fairly recent entry. What does Theme Hospital have?

Well, thanks to the efforts of Two Point Studios, Theme Hospital now has a proper spiritual sequel: Two Point Hospital, only the second-ever game I’ve ever played about building a hospital and trying not to kill a majority of your patients.

To which I can only say: I’ll try.

(Spoiler levels: Narrative, nil. Mechanical, medium.)

(Game source: Patreon funds.)


Not at all the graphical style I expected, but… maybe it’s the graphical style I need right now.

Two Point Hospital opens on a surprisingly non-medicinal top-down landscape, and a surprisingly non-medicinal relaxed bongo beat. This isn’t one of those European/American cultural misunderstandings of what ‘medicine’ means, is it? Quick, let’s take a look at the options before you’ve given the preceding statement any sort of serious thought!

I know it doesn’t make a lot of sense, but look! Graphics settings! Audio sliders! And look at this confusing ‘Log Level’ setting! I don’t even know what it does!

I futz around in the options a little bit, but there’s nothing out of the ordinary here. And honestly, what I really want is to get into the business of curing people already. New Game, first save slot, yes I’m sure, go.

An introduction plays. It’s fully-voiced, but doesn’t allow subtitles, which means I can actively feel myself forgetting what is being said — the only line that sticks with me is the line ‘fully 52% of patients report feeling healthier when they leave than when they arrive’, delivered by this charming professional-looking gentleman.

He’s so charming, you’ll forget all about paying any attention to the top right window.

I’m treated to a rapid succession of images. A person locked inside a coffin of sorts. A person made entirely out of cubes. A person with a small green head, talking to what I assume is a psychiatrist. A clown. I assume these are snapshots of things to come, but they come so rapidly and so without context that I can’t even pretend to be parsing them. Then everything suddenly explodes in a cloud of white smoke. And when that smoke clears…

Initial impressions

…I’m greeted by Albert Crank, my trusty advisor. And also I’m in the sky, for some reason.

My isometric camera hovers over a small hospital town on a nice bay island. My trusty advisor Albert explains that this is Hogsport, and it’ll be my first hospital, and that I should click on it to get started. Then he dives below the screen edge and disappears, leaving me bereft of any further trusted advice. But that’s alright: His job here is done.

I won’t say I wouldn’t have liked any further advice on all these UI elements that just appeared, but I get it. Albert’s a busy man.

I click around in the UI a little bit. The buttons in the bottom left provide, respectively: The options menu I already addressed, a list of game achievements that have no value to me right now, and a surprisingly non-empty leaderboard. In the bottom right, I can see my ‘stars’ (zero), my ‘K’ (also zero), myself (hero), my cash and share price, and the name of my foundation, whatever that means. I rename the generic ‘Two Point Foundation’ to ‘Ninja Blues Foundation’, then resolve to tell all readers about the fact that you can rename your foundation this way, since Two Point Hospital itself seems preoccupied with not telling me anything of the sort.

A non-insignificant number of my Steam friends have played this game! I intend to defeat *all of them*.

Clicking on the Hogsport hospital gives me some more granular information re: Which of my friends have been doing what. I can actually get detailed information about their hospitals’ value, level, reputation, and balance, providing me with all the necessary information to grind them into the dirt. I can also use this screen to actually start the dang game, which I’m going to have to do at some point if I actually want to beat anyone.

Dang you, Ninja Blues friend and supporter Muse! You’ll pay for this *successitude*!

Another white smoke cloud later, I find myself looking at my first hospital.

Upside: It’s roomy.

As ‘Bassinets’ by ‘Jorge & The Deuce’ starts playing, a popup-tutorial teaches me how to get about in Two Point Hospital. Step one: Use WASD, the right mouse button, and the mouse wheel for camera control. Check.

Look ma, I’m zoomed all the way out!

Step two: Select the Items menu, select a Reception desk, and put it near the entrance. Then open the Hire menu and hire an assistant to man that desk, so that new patients can actually check in. Check.

My pool of potential assistants is limited, but on the plus side, this person *will* help me move.

Step three: Patients will need to visit a primary care provider first. Open the Rooms menu, select the GP’s Office, and make a floor plan that’s at least 3×3. Then select items to place inside the office, three of which must be a door, a desk, and a… filing… cabinet…

I’m getting a twenty year sense of deja vu.

I sit in a quiet memory trance as Two Point Hospital takes me through the steps of hiring a doctor, getting a patient diagnosed, then building a pharmacy and hiring a nurse so they can get treatment. This is… I expected Two Point Hospital to be a spiritual successor to Theme Hospital, sure. But so far this isn’t a sequel to Theme Hospital, it is Theme Hospital. It’s beat-for-beat taking the exact same steps I remember playing over and over in that first level, back when I didn’t even fully realize why these were the steps I was taking. I… appreciate that this isn’t going to be relevant to a great deal of readers, but I need you to understand how closely these two games feel like the same thing right now. For a moment I even imagine I can hear Theme Hospital‘s announcer voice saying something about room occupancy, but then I shake awake and realize that Two Point Hospital’s announcer voice is almost the exact same voice. I actually had to look up just now if they weren’t actually the same person, that’s the level of overlap we’re on.

I realize I’m actually fine with Two Point Hospital being more of a modern-day remaster than a spiritual successor. The first game worked well enough, I’m not saying no to being able to play it in a modern settings. I can’t wait to see the first disease based around smartphones existing.

Anyway. A quick overview of Two Point Hospital‘s action flow is this: Patients enter the hospital with some unknown disease. They first visit a GP’s office, where a doctor tries to diagnose their illness. I keep a close eye on my first patient here; it’s possible to check in during every step of the process, to track the patient’s health, happiness, and progress. I’m actually pretty impressed with the level of detail and overall aesthetic of these character models, and with that of the game overall.

There’s a decent amount of information on-screen at the same time, but I hope that’ll start fading to the background once I learn what most of it actually does.

It’s possible that one GP visit is all it takes. In the case of my first patient, the GP diagnoses them with Grout, which… yup, that’s about the level of Theme Hospital writing that I remember. Curing Grout requires a mixture from the in-hospital pharmacy, meaning I need to build one such pharmacy and staff it with a nurse.

Or I could just tell the patient to go take a hike.

The patient walks into the pharmacy, which right now is a big boxy room with a giant machine that technomagically mixes cures. The nurse operates the machine, takes out the concoction, and hands it to the patient, who chugs it right there and then. A big heart icon appears over their head; they’re cured! They walk out with a smile on their face, and my bank account goes up by five hundred dollars.

I’m assuming Americans made this game.

At this point, Two Point Hospital takes a step back, folds its hands, and goes ‘alright, you’ve figured out medicine. But have you figured out humans?’ Or it would, if it were a mysterious stranger who drove into a small American town one day to single-handedly revive its abandoned art school. But since Two Point Hospital is a video game instead, what it actually does is tell me that I need janitors now, to look after machinery. And I should probably buy some snack and drink machines for patients and staff to feed themselves with. And some benches, so people can sit. And some entertainment. And a staff room, so staff can take breaks from work. And a toilet, maybe.

It’s such a waterfall of messages, I forget to take good overview shots of my hospital in favor of documenting all these lessons.

Getting back into the medicine grind, it’s not always as easy as ‘see a GP, get a drink, done’. If the GP can’t determine the illness with enough certainty, secondary diagnosis is required. Such as the General Diagnosis room, where a nurse uses a magical diagnosis machine to… well, you get the idea. Key here, Two Point Hospital emphasizes, is that a patient will always have to check in with a GP after any secondary diagnosis. So right now, while the hospital is calm and the diseases are easy, I’ll be fine. But later on…

Oh, and as I cure more people and expand the hospital, more patients will seek out this place to get healed. No pressure, though.

And then Two Point Hospital actually steps back, and lets me work. And days, weeks, months start going by in the background, as I build a new room here — hire some more staff, including a secondary assistant so the first can take breaks — put some plants here and there, because plants are nice and they improve the hospital’s Attractiveness rating, which I assume brings in more people — hire an extra janitor, because between the plants and the bathrooms one might not be enough…

I’m vaguely aware that at the end of every month, a financial overview quickly pops into view in the lower right corner. Revenue in green numbers, expenses in red. Initially, the latter consistently looks higher than the former.

Listen: Getting a hospital set up is expensive work, okay.

I’m vaguely aware of it, but most of my attention is drawn to other things. For instance: I’m alerted to the existence of a new disease, Lightheadedness, which requires a specialized facility to cure. Or diseases that require the bed-heavy Ward, both for diagnosis and treatment. I even find my first case of an unclear diagnosis: One of my patients has been diagnosed with only 89% certainty. Do I make them wait until I build new rooms, which is functionally instantaneous if I pause the game’s time flow and build something right there and then? Send them home? Or take the shot at curing them, knowing that a bad diagnosis like this translates in a higher risk of failure and even death?

Heavy stuff.

The Lightheadedness disease is actually so important that the Ministry of Health decides to make it my first major objective. I am to cure three people with that disease, and in return my hospital will get a one-star rating! Let’s take a look at what all that entails…

First off, this is Lightheadedness.

This seems like it won’t be hard to diagnose.

Lightheadedness is addressed in the De-Lux Clinic, where the patient takes place in a special machine. The machine screws off their lightbulb head, throws it in the bin, then generates a new head with a 3D printer and puts that back on. It’s probably the best visually weird disease Two Point Hospital could have started off with: Strange, funny, and kind of gruesome, if you think about it for too long.

They’re fine, don’t worry.

But once the procedure is completed, the patient walks out healthy as can be, and I get my first mark on the three-cures tally boa-

Or, or maybe that happens.

Well. Better luck next time?

Let’s actually skip ahead to the point where I manage to cure three Lightheaded people without killing them.

One star! This is all I ever wanted out of life.

Here, Two Point Hospital reveals its larger structure to me. On the one hand, by gaining one star in Hogsport, I unlocked a new hospital area to play in: Lower Bullocks, a larger hospital with more diseases, more rooms, and more opportunities to mess up. On the other one, my one star is only one star out of a possible three. I could opt to keep playing in Hogsport instead, and work towards the newly-revealed objectives for a 2-star hospital instead: Curing 25 patients, earning $200.000, and getting the hospital to ‘level 6’.

I’m given to understand plants are involved in the latter.

And I realize — I kind of want to do both? I’ve been playing for half an hour, but it feels like only minutes have passed. And I can see the appeal in both paths: A new hospital probably means new fun things to do, but I did just get a tangible reward for reaching that first star — wonder if I’ll get anything for the later stars? Plus, I did make it my personal mission to grind all my friends into dust. And I can’t do that with a one-star hospital, can I?

Decisions, decisions. It’s enough to make me lightheaded.

Onto page 2. >>


  1. Even passively through a phone screen, the nostalgia is like a brick to the gut. When I played Theme Hospital, I was young enough that I couldn’t figure out how to get back to the main menu, let alone help these poor, hilariously ill people. To this day I can picture heads being… deflated. Glorious.

    5/5, would Jarenth again.

    1. The deflating heads and the invisible people are probably my two strongest points of visual memory from Theme Hospital. Aurally, of course, I mostly remember the shrill repeating shout of “doctor required in GP’s office!“.

  2. This is one of those curious games where I’ve played for 40+ hours, but it’s hard to say if I was having fun for a lot of that time. As you’ve mentioned, there’s a big gap between playing for fun and playing to win, and I’m definitely the sort of person that plays a game like this to make the numbers go up as high as possible.

    A lot of the things you need to do to play successfully involve making counter-intuitive decisions. Patients need things like benches and snack machines, right? Wrong! You should ignore all of that as it distracts patients, and they’ll wander halfway across the hospital for a snack when they should be entering a room, holding up those behind. With no patient-amusing items, they’ll just line up in an orderly fashion by the door and wait.

    You’d think that having a variety of rooms would be helpful, but wrong again. Once you unlock the Fluid Analysis diagnosis room, you’ll never want to build General Diagnosis or Cardiology again, as they’re less efficient than FA for nearly all diseases.

    Reputation is a good thing, yes? No. Reputation quickly leads to an excess of patients. Long queues and deaths inevitably follow. Here’s what you do – jack up all treatment prices to 100% as soon as you discover new diseases. It lowers patient happiness, but after treatment they’re either going home or dying, so their happiness is irrelevant. The increased income offsets the lower number of patients, and money basically becomes a non-issue. Money being completely irrelevant is not a great look for a sim game.

    There’s some seriously baffling decisions that should have been caught with only minor testing, too. Certain items provide bonuses to diagnosis/treatment chance, and they stack with no diminishing returns. Didn’t the devs realise this would lead to people making huge rooms consisting of 1 GP’s desk, 1 filing cabinet and 90 Medicine Cabinets? The Clock Ward is just scratching the surface. Prestige boosting items are nearly all useless too – unlock the Gold Certificate to hang on walls and every room can be 5 Prestige with no effort. As Prestige increases staff happiness, which increases treatment skill, this means you can either have ugly rooms papered in certificates, or nice looking rooms with lower prestige, meaning unnecessary patient deaths. As a ‘bonus’, these super-GP rooms make every diagnostic-only room obsolete.

    The way research works is bizarre too. All research can be done on any level, so whenever a new treatment room needed researching, I’d just pop back out to the map, jump over to Mitton and my big research wing, and knock it out in 60 seconds. A room that only needs to be built once across the whole campaign is odd.

    Many of my complaints revolve around things that can be changed with tweaks to numbers and such. The stuff that can’t easily be changed, such as the art, music, and general tone of the game, are top-notch. A couple of the main devs worked for Bullfrog for some time, including working on Theme Hospital, so that’s no surprise. ‘Wet Laundry’ is a particularly hard song to shake, and the announcer reminding patients not to die in the corridors is not yet annoying, to my surprise.

    All in all, TPH is fun, but I feel a few months of Early Access on Steam, with a few thousand folks paying to beta test would have been beneficial. The devs are active on the Steam forums and have already released multiple fixes and improvements, such as the ability to copy and paste rooms, so the future looks bright. I hope the game does well, as I’d like to see a whole series of sim games across Two Point County.

    1. This comment reads like a manifesto that eventually resulted in American Healthcare.

      (I agree, of course, with everything — it was difficult for me to not give into the Medicine Cabinets Everywhere urge)

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