Demographic, economic and federal policy trends are supporting a market shift to outpatient medical buildings and away from hospitals in the U.S., according to healthcare real estate specialists.
For the U.S. population, “we are in the midst of what's called a silver tsunami,” Ian Anderson, senior director of research and analysis for U.S. office, life sciences, and healthcare at CBRE, said in a webinar on the company’s 2026 real estate market outlook. “The senior population of the United States is projected to grow by roughly 50% over the next 10 years.” As people age, their spending on health care tends to increase.
Meanwhile, health care cost concerns are increasing. Changes in the One Big Beautiful Bill Act are expected to increase the number of people without health insurance by nearly 14 million, Anderson said, and medical supply costs are rising.
With payment policy changes by the Centers for Medicare & Medicaid Services that include allowing more procedures to be done outside of hospitals, healthcare providers are placing greater emphasis on more affordable outpatient facilities as part of their portfolio optimization, CBRE said in a healthcare real estate report.
“The most consequential shift in federal health care policy since Obamacare will be unfolding over the next several years,” Anderson said. “There will be headwinds. But how these headwinds intersect with these favorable demographic megatrends may actually benefit the medical outpatient building sector in a couple of surprising ways.”
JLL, in a medical outpatient building fit-out cost guide released Wednesday, looked at expectations for where healthcare services will be provided in the near future. Outpatient volumes are expected to increase 8% over the next five years, compared with just 1% for inpatient volumes, it said. Much of the increased demand will stem from shifts in care to office and clinic sites that have low-intensity fit-outs, JLL said. Moderate-intensity fit-outs, like standalone physical therapy facilities and labs, are also expected to see strong growth, helping drive increased demand for purpose-built medical office buildings, or MOBs, and conversions of other retail and office spaces into medical uses, JLL said.
Rising costs from complexity
Against these growth drivers are sector constraints, like tightening subcontractor capacity, that are pushing fit-out costs higher, especially in high-growth metro areas, and concentrating demand into fewer new projects, JLL said in its cost guide.
In 2026, the average cost of all-in MOB fit-outs in the U.S. is $412 per square foot, according to the guide. That amount includes midpoint benchmarks for hard costs, soft costs, design and service fees, audio-visual equipment and IT, contingency costs and furniture, fixtures and equipment. It does not include structural and infrastructure upgrades, demolition and phasing constraints and off-hour work and wage premiums. Hard costs contribute slightly more than half of total fit-out budgets, at $226 per square foot, the guide says.
Delivery constraints are pushing providers and investors into renovations and conversions instead of new construction, JLL said. But the operational constraints, phasing and infrastructure upgrades those projects require are increasing complexity and driving widening cost variability and higher contingency needs, it said.
The shift toward outpatient facilities is also fundamentally changing space requirements and costs, the JLL report states. Higher acuity ambulatory care facilities that provide more high-acuity care, such as imaging, surgery and cancer care, for example, function as mini-hospitals from a power and mechanical, electrical and plumbing standpoint, substantially raising the cost per square foot for fit-outs, it says. More tech-enabled outpatient care also increases furniture, fixture, equipment, audiovisual and IT costs, JLL said.
The firm estimates fit-out costs for moderate-acuity facilities — like those with expanded imaging or specializing rooms — to be roughly 10% higher than baseline outpatient facilities — those that only include examination and waiting rooms and basic IT infrastructure. High-acuity MOBs, with equipment requiring additional structural considerations due to their weight and power use, are estimated to cost an additional 20% over moderate-complexity fit-outs, JLL said.
Labor remains the primary cost escalator and the largest source of schedule-driven premiums, with wage pressure and uneven subcontractor capacity — especially mechanical, electrical and plumbing and specialty trades — continuing to drive bid volatility, the report says.
