With in a hospital, major cost elements associated with health care are: people, energy, equipment and maintenance. Expenditure associated with people dominates hospital operating costs. Planners have underestimated the capacity of relatively untrained personnel to participate in the delivery of health care. Increasing fuel costs, unnecessary use of energy and inefficient building designs have made energy the second most costly element in health care in hospitals. Medical equipment is becoming obsolete more and more quickly requiring replacement more frequently. Increasingly sophisticated equipment is demanding higher outlays of capital for equipment. Poor designs and increasing complexity increases hospital maintenance costs as health delivery services are disrupted by repairs and routine maintenance.