A hospital's Bilan Carbone®: which categories weigh most?

The healthcare sector accounts for 8% of France's carbon footprint, 49 MtCO₂e per year (The Shift Project). More than aviation. Hospitals concentrate 38% of this. The national target: -5% per year by 2030, set by the healthcare system's ecological planning roadmap (December 2023).

This guide is for establishment directors, finance directors, pharmacists and sustainable development managers who want to understand the real structure of a hospital's footprint and know where to start in practice.

1What is a hospital Bilan Carbone®?

A hospital Bilan Carbone® is a complete snapshot of a healthcare establishment's greenhouse gas emissions across the GHG Protocol's three scopes. Its distinctive feature compared with a conventional industrial assessment: scope 3 represents 84% of the total. Most of the issue lies in medical purchases, rather than the buildings.

Orders of magnitude observed in published inventories:

• University hospital (1,000 to 2,000 beds): 50,000 to 200,000 tCO₂e per year
• General hospital (300 to 800 beds): 15,000 to 60,000 tCO₂e per year
• Private clinic (100 to 300 beds): 5,000 to 20,000 tCO₂e per year
• Per inpatient day: 312 kgCO₂e on average (AP-HP 2024)
• Per FTE: 21 tCO₂e on average (AP-HP 2024)

AP-HP, Europe's largest hospital network, published its 2024 Bilan Carbone®: 1.94 million tCO₂e across all its sites. A significant point: these emissions increased by 7.9% between 2023 and 2024, driven by growth in healthcare purchases. Decarbonising a hospital while increasing activity is a structural challenge rather than an exercise in marginal optimisation.

2Where a hospital's emissions come from

The breakdown is counter-intuitive. Conventional intuition puts energy first. Reality is very different.

• Medical purchases: 50 to 70%, medicines (29-40%) and medical devices (15-25%). By far the dominant category
• Energy: 10 to 20%, heating, operating theatre air conditioning, MRI/scanner cooling. A hospital operates 24 hours out of 24
• Food: 3 to 5%, catering
• Travel: 3 to 5%, staff, patients, visitors, ambulances
• Waste (including infectious healthcare waste): 2 to 4%, a minor carbon category but a direct financial opportunity
• Anaesthetic gases: 1 to 3%, small in volume, enormous in warming potential
• Scope 1 + 2: only 16%, the rest (84%) is in scope 3

Why medicines weigh more than the boiler plant. Synthesising a complex molecule, a monoclonal antibody, anticancer medicine or immunosuppressant, requires high-temperature chemical processes, solvents, intercontinental logistics and a strict cold chain. The Ecovamed methodology documents the differences: 38 gCO₂e for a dose of paracetamol, several hundred kgCO₂e for certain monoclonal antibodies. A ratio of 1 to 10,000 between the extremes.

3The 2026 regulatory framework

Four frameworks converge on healthcare establishments in 2026. Knowing them makes it possible to sequence work and unlock budgets: in a hospital, compliance is often the argument that secures approval of a budget line in the executive committee.

• Mandatory BEGES: every public establishment > 250 staff (almost all general and university hospitals), three-yearly publication on bilans-ges.ademe.fr, scope 3 included since 2022 (private clinics: above 500 employees, every 4 years, scope 3 only under CSRD), mandatory transition plan (Green Industry Act). Penalty: €50,000
• Tertiary Decree: -40% energy consumption in 2030 for all buildings > 1,000 m². Annual reporting on OPERAT
• Green public procurement (22 August 2026): mandatory environmental criterion in every new public contract, including medical purchases. Direct impact on the dominant category
• Ecological planning roadmap (Dec. 2023): -5% emissions/year for the sector, -2.5% for hospitals, ministerial monitoring

What changes in practice this year: CSRD, refocused by the Omnibus I Directive on companies with more than 1,000 employees and €450 million in turnover, now targets only the largest private clinic groups. And territorial hospital groups (GHTs) are increasingly assessed on carbon indicators consolidated by regional health agencies, sharing the process but requiring a consistent methodology across the group.

4Pitfalls to avoid

Four mistakes consistently recur in establishments launching their first initiative.

Focusing on energy rather than purchases

Energy is visible: bills, meters and the Tertiary Decree. Medical purchases are opaque: public procurement, hundreds of lines and scarce emission factors. As a result, many establishments launch an energy performance contract or replace lighting with LEDs and think they have addressed the issue. Energy accounts for 10 to 20% of the footprint. Purchases account for 50 to 70%. An action plan focused on energy alone misses the dominant category.

Delegating without management backing

A Bilan Carbone® led by a sustainable development officer without an executive committee mandate produces a report nobody reads. In a hospital, data collection involves pharmacy, procurement, logistics, technical services, IT and finance. Without backing at the highest level, departments do not respond and the assessment remains superficial.

Ignoring scope 3 through lack of data

Scope 3 represents 84% of the footprint. BEGES has required it since 2022. Some establishments limit themselves to scopes 1 and 2 because medical procurement data are difficult to collect. The result is a non-compliant inventory and, above all, one that is useless for managing a reduction strategy. Spend-based ratios (kgCO₂e per k€ of purchases) are imperfect but sufficient for an initial exercise.

Forcing the pace of collection

A well-run hospital BEGES involves 50 to 70 people over 6 to 12 months. Not 15 people over 3 months as in an industrial SME. Healthcare staff fulfil a vital mission that absorbs all their energy. Forcing the pace undermines support and produces a report without an implemented action plan.

5Reduction measures and their quantified impact

Measures fall into two categories: those producing results within a few months, quick wins, and those delivering most of the reduction but taking a procurement cycle or substantial investment.

Quick wins: anaesthetic gases and infectious healthcare waste

Replacing desflurane. Desflurane has a warming potential 2,540 times greater than CO₂. Sevoflurane: 130 times. Removing desflurane when clinically possible = -90% of inhalational anaesthesia emissions. A typical saving for an average university hospital: 500 to 2,000 tCO₂e avoided per year, zero investment and sometimes even a financial saving, since desflurane is more expensive per litre. Several French university hospitals have already removed it from their pharmacies (Nantes, Bordeaux, Strasbourg). SFAR also recommends reducing nitrous oxide and decommissioning ageing centralised networks.

Sorting infectious healthcare waste. Infectious healthcare waste costs €500 to €1,000/tonne to treat compared with €150 to €200 for household waste. Yet 30 to 50% of the contents of yellow bins is not infectious healthcare waste: packaging, clean gloves and unsoiled swabs. A waste characterisation audit + targeted training = -15 to 25% of volumes within a few months. For a 500-bed hospital: €13,000/year in savings and 13 tCO₂e avoided.

These two quick wins build support for structural work. The finance director sees infectious healthcare waste savings, and medical staff see that replacing gases does not compromise care quality.

Structural measure: medical purchases

The dominant category takes a procurement cycle (3-4 years) to change. Four converging approaches:

• Environmental criteria in public procurement: mandatory since 22 August 2026 (Art. L. 2152-7). Requesting an emission factor per product is becoming standard
• Reusable versus disposable: comparative LCA documents a -38 to -56% change in the footprint of devices (gowns, drapes, operating theatre instruments)
• Reducing excessive packaging: the PHARE programme encourages suppliers to review packaging
• Substituting molecules with lower-impact alternatives with the hospital pharmacy, through the Ecovamed methodology

A well-used procurement cycle can cut the procurement footprint by 10 to 20%, or several thousand tCO₂e per year for a university hospital.

Energy: meeting the Tertiary Decree

A hospital runs 24 hours out of 24, 365 days per year. Constant-temperature operating theatres, MRIs requiring cooling, laboratories and kitchens. Heat has also become a compliance issue since the decree of 27 May 2025, detailed in what actually requires an organisation to adapt. Constraints are considerable, but measures exist: energy performance contracts (-20 to -30% over the contract period), heat recovery from chillers and compressors (10-20% on hot water), LED lighting replacement (12-24-month payback, -60 to -70% on lighting), fine control of air handling units. The national savings potential: €550 million/year (IGAS 2024).

6Costs and funding

A complete Bilan Carbone® (scopes 1-2-3, action plan, presentation to management) costs €15,000 to €40,000 excluding VAT depending on size. For a territorial hospital group pooling the work: up to €50,000 excluding VAT. Duration: 4 to 8 months, including 2 to 4 months of data collection.

• Diag Décarbon'Action: €6,000 excluding VAT payable for private clinics with fewer than 500 employees, with public hospitals excluded
• Ecological Transformation Fund (France 2030): specific grants for public establishments, managed by regional health agencies
• BPI green loans and zero-interest eco-loans for energy investments following the assessment
• Regional health agency calls for projects on decarbonisation: published regularly, varying by region

7Our advice: where to start

When an establishment director asks us where to start, we give three steps. Because they work every time, rather than because they look ideal on paper.

Step 1 - Check your eligibility for Diag Décarbon'Action

The ADEME/Bpifrance programme funds 40% of the first inventory. Conditions: fewer than 500 employees, at least 1 year of activity, no GHG inventory in the past 5 years (private clinics, rather than public hospitals). Amount payable: €6,000 excluding VAT instead of €15,000 to €40,000. It takes 5 minutes on the BPI website. For ineligible public establishments, contact your CTEES (healthcare energy and ecological transition adviser) attached to the regional health agency: it is free, and they direct you towards the right funding.

Step 2 - Start quick wins even before the assessment

There is no need to wait for the complete Bilan Carbone® to act. Infectious healthcare waste audit (bin characterisation + training = €13,000/year in savings, visible within 3 months). Pharmacy audit of anaesthetic gases (removing desflurane = free and immediate). These two actions give the approach credibility with the executive committee and healthcare teams. We consistently recommend launching them alongside scoping the inventory.

Step 3 - Gather your basic data

80% of what is needed is already in your systems. The key documents for a hospital: 12 months of energy bills (gas, electricity), OPERAT data if tertiary reporting is done, infectious healthcare waste volumes and costs by department, medical procurement data by family (pharmacy + procurement department), headcounts and floor areas. The hardest part is getting the data back from the 5 or 6 departments concerned rather than finding it. Hence the importance of backing at the highest level from the outset.

8Key takeaways

A hospital Bilan Carbone® has a counter-intuitive structure and a massive scope 3. But measures exist: some are free, others generate direct savings.

• Healthcare accounts for 8% of national emissions (49 MtCO₂e). Hospitals concentrate 38%
• 84% in scope 3, dominated by medical purchases (50-70%). Energy = 10-20%
• Two free quick wins: remove desflurane (-90% anaesthesia, zero cost) and audit infectious healthcare waste sorting (-15 to 25% of volumes, €13,000/year for 500 beds)
• The structural measure lies in public procurement of medical products: mandatory carbon criteria from August 2026
• Budget: €15,000 to €40,000 excluding VAT, funding available (Diag Décarbon'Action, regional health agencies, BPI)
• BEGES, Tertiary Decree, green public procurement, CSRD: four frameworks converge and make the approach essential

Establishments launching the process will be ready for the three-yearly BEGES and the 2030 Tertiary Decree, while green public procurement is already in force. Those waiting will have six months to do eighteen months' work. The good news is that quick wins are free, funding exists and CTEES advisers are there to help free of charge. So get started!

Further resources

Frequently asked questions

1What is the average Bilan Carbone® of a hospital in France?

It varies greatly with size. A university hospital (1,000-2,000 beds): 50,000 to 200,000 tCO₂e/year. A general hospital (300-800 beds): 15,000 to 60,000 tCO₂e/year. A private clinic (100-300 beds): 5,000 to 20,000 tCO₂e/year. Reference: AP-HP emits 1.94 MtCO₂e/year, or 312 kgCO₂e per inpatient day.

2Is a hospital required to carry out a Bilan Carbone®?

Yes, from 250 staff for a public establishment (500 employees for a private clinic), meaning almost all general and university hospitals. Regulatory BEGES is mandatory every 3 years, with scope 3 included since 2022 and a mandatory transition plan since the Green Industry Act. Penalty: €50,000.

3How much does a complete hospital Bilan Carbone® cost?

Between €15,000 and €40,000 excluding VAT for an establishment, up to €50,000 excluding VAT for a territorial hospital group pooling the work. Duration: 4 to 8 months. Diag Décarbon'Action reduces the amount payable to €6,000 excluding VAT for private clinics with fewer than 500 employees.

4Why do medicines weigh more than energy?

Chemical and biological manufacture of active ingredients is extremely energy-intensive: high-temperature synthesis, solvents, intercontinental transport and the cold chain. The Ecovamed methodology documents differences of 1 to 10,000 between molecules. Without scope 3, only 16% of the footprint is visible.

5Which reduction measures are fastest?

Two free, immediate measures: remove desflurane (-90% anaesthesia emissions, zero investment) and improve infectious healthcare waste sorting (audit + training = -15 to 25% of volumes within a few months, €13,000/year in savings for 500 beds). The structural measure: include carbon criteria in public procurement of medical products (3-4-year cycle).

6What is the difference between BEGES and Bilan Carbone®?

BEGES is the regulatory format (ADEME categories, publication on bilans-ges.ademe.fr). Bilan Carbone® is the ABC method: breakdown by department, detailed action plan and indicator management. In practice, both are done in a single exercise.

7What is a CTEES and how do you contact one?

Healthcare energy and ecological transition advisers are 150 professionals deployed by ADEME and regional health agencies since 2023. They support establishments free of charge: structuring the approach, accessing funding and monitoring the roadmap. Attached to regional health agencies, they can be contacted through your senior management.

8What is the healthcare sector's carbon footprint in France?

Healthcare accounts for 8% of France's carbon footprint, or 49 million tCO2e per year according to The Shift Project, more than aviation. Hospitals concentrate 38%. In an establishment, 84% of emissions fall within scope 3, dominated by purchases of medicines and medical devices. The healthcare system's ecological planning roadmap, published in December 2023, sets the sector a target of a 5% reduction per year by 2030, with ministerial monitoring.

9Which categories dominate a hospital's Bilan Carbone®?

Medical purchases, representing 50 to 70% of the footprint: medicines (29 to 40%) and medical devices (15 to 25%). Energy accounts for only 10 to 20%, despite operation 24 hours out of 24 with air-conditioned operating theatres and imaging equipment requiring cooling. Next come food (3 to 5%), staff, patient and visitor travel (3 to 5%), waste including infectious healthcare waste (2 to 4%) and anaesthetic gases (1 to 3%), low in volume but with very high warming potential. In total, 84% of emissions fall within scope 3.

10What is the regulatory framework for hospitals?

In 2026, 4 frameworks apply to hospitals. BEGES is mandatory every 3 years for public establishments with more than 250 staff and every 4 years for private clinics with more than 500 employees, with a transition plan and a fine of up to €50,000. The Tertiary Decree requires -40% energy consumption in 2030 for buildings above 1,000 m², with annual reporting on OPERAT. Since 22 August 2026, every new public contract must contain an environmental criterion, including medical purchases. Finally, the December 2023 ecological planning roadmap targets -5% emissions per year for the sector.

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