Game End and Scoring
Track Prestige during play, then compare hospital quality and development.
Prestige
During every Cleanup, gain Victory Points equal to half your Prestige, rounded down. Curing Patients and card effects provide other points and rewards.
End of the game
The game ends after round 7, or at the end of an earlier round when the Congress Doctors left on the board reach the threshold for player count:
| Players | End trigger |
|---|---|
| 2 | 8 or fewer Congress Doctors remain |
| 3 | 6 or fewer remain |
| 4 | 5 or fewer remain |
Final scoring
Apply the points or penalty shown at your Quality of Care position:
| Quality of Care | Final points |
|---|---|
| 13 | +4 |
| 12–11 | +3 |
| 10–9 | +2 |
| 8–7 | +1 |
| 6 | 0 |
| 5–4 | −1 |
| 3–2 | −2 |
| 1 | −3 |
Then, for each of these tracks, gain one Victory Point for every opponent you are ahead of: Quality of Care, Insurance Companies, Prestige, Credit production, Diagnostics, Healing, Research and Staff.
The highest total wins. Ties break by Quality of Care, then Prestige, fewer Patients in the hospital, higher treated-patient track, higher Credit production, higher combined Diagnostics/Healing/Staff/Research production, most level-5 Insurance Companies, then the highest Credit cost among your played cards.
Quality of Care
Quality of Care affects how many extra Medical cards you draw at the start of each round and sets a final score or penalty. Advances raise it through Insurance Companies, the Ambulance track and cards. The track has limits: additional gains at its maximum and losses below its minimum do not change the marker. See common clarifications.