Review: Dice Hospital

Introduction & Overview

In Dice Hospital, players must treat as many patients as possible to appease the local authorities. You will have to assign hospital staff to treat patients on your player board. However, you will also need to bring in specialists to react to emergent situations, allowing you to score bonus points with the authorities.

This is the premise of Dice Hospital, designed by Stanislav Kordonskiy (Lockup: A Roll Player Tale, Old West Empresario) and Mike Nudd (Waggle Dance, Vampire: Prince of the City). The game was published in 2018 by Alley Cat Games following a successful crowdfunding campaign offering two versions (standard and deluxe). The artwork is illustrated by Sebastián Koziner (Heroes of Terrinoth, Cosmic Run: Rapid Fire, The Little Flower Shop) and Sabrina Miramon (Quadropolis, The Builders, Photosynthesis).

It supports 1 to 4 players, with a recommended minimum age of 10 and an approximate playtime of 45 to 90 minutes. The MSRP is €40. For this review, a copy of the Spanish edition by Maldito Games was used.

Important: if you already know the game and/or are only interested in my opinion about it, you can go directly to the Opinion section. The Content and Mechanics sections are especially intended for those who do not know the game and prefer to get a general idea of how it works.

Go to Personal Opinion

Components

Inside a two-piece cardboard box (lid and bottom) measuring 31.5×30.6×5.6 cm (a square box similar in dimensions to Hamsterrolle, but with slightly less depth), we find the following components:

• 63 Six-sided dice (21 in each color: red, yellow, and green) (resin)
• 32 Large Cards (63.5×88 mm):
  • 24 Specialist Cards
  • 4 Administrator Cards
  • 4 Player Aid Cards
• 25 Small Cards (63×44.5 mm):
  • 5 Ambulance Cards
  • 8 Event Cards
  • 12 Medical Report Cards
• 4 Player Boards (cardboard)
• 24 Department Improvement Tiles (cardboard)
• 12 Fatality Tokens (cardboard)
• Score and Round Tracker (cardboard)
• 4 Score Markers (cardboard)
• 16 Blood Bag Tokens (cardboard)
• 36 Doctor Meeples (wood)
• Dice Bag (cloth)
• First Player Marker (cardboard)
• Rulebook

How to Play

Dice Hospital is, as its name suggests, a hospital management game in which, over the course of 8 rounds, players receive patients represented by dice whose values indicate how sick they are. The goal is to discharge as many dice as possible each round. To do this, players will use nurses and doctors, along with various hospital rooms and departments (more can be acquired during the game) that allow treating these dice and altering their values. At the beginning of each round, a new ambulance arrives with 3 dice to treat. At the end of each round, untreated dice will deteriorate (potentially dying), while discharged patients award points based on the number discharged simultaneously.

Key Concepts

Let us begin with the Dice, as they are the core element of the game. These dice represent patients admitted to our hospital. There are three different colors: red, yellow, and green. The value shown on a die indicates the severity of the patient’s condition. The higher the value, the healthier the patient. Thus, a die showing a 6 represents a patient ready for discharge, while a die showing a 1 is on the brink of death.

These patients arrive at the hospital in Ambulances, represented by cards with spaces for 3 patients. These ambulances are numbered, determining turn order in certain game phases. There will always be one more ambulance in play than the number of players. At the start of each round, these ambulances are loaded with rolled dice to determine their initial severity, placed in ascending numerical order across the ambulances (from lowest to highest value). Consequently, the lowest-numbered ambulance (granting first pick in the subsequent phase) will carry the most critically ill patients.

Each player’s hospital is represented by a player board where the various departments and rooms are laid out in hexagonal spaces across three rows. The bottom row contains the wards, each with three beds, giving a total capacity of up to 3 patients per ward. Each bed has two positions: the upper position holds an untreated patient, while the lower position indicates that the patient has received treatment this round. The top two rows feature various departments where an action can be activated to treat patients meeting specific criteria (value and/or color). The middle row contains 3 special spaces: on the left, the Morgue, where deceased patients accumulate; in the center, the Staff Lounge, where available meeples are placed; and on the right, the Discharged Patients area, where fully healed dice go. Players score points based on the number of patients discharged at the end of each round, and lose points at game end for any deaths that occurred in their hospital.

Each department can be activated once per round. To do so, a meeple must be assigned to activate it. Players start the game with 3 white nurses, but can recruit new specialists in different colors throughout the game.

These Specialists are represented by cards that grant an additional effect to the matching colored meeple. This means that, beyond activating a room, the meeple itself can apply an extra effect to the dice treated in that department.

Another special card type is the Administrator. Each player begins the game with one administrator card, providing a unique permanent effect for the entire match.

Hospitals can also be expanded by drafting new Departments, represented by hexagonal tiles that fit onto the hospital board.

To avoid leaving dice in the morgue, the game includes Fatality Tokens that players receive whenever one of their patients passes away.

The only spendable resource in the game is Blood Bags. Each round, the player who chooses the lowest-numbered ambulance takes the first player token and receives a blood bag token. Blood bags can be used in two ways: to directly heal a die by increasing its value by 1, or to temporarily change a die’s color to meet a department’s activation requirements. This color change lasts for the entire round.

Finally, scoring is tracked on the Score Tracker, which features a numbered grid from 0 to 40. Players use double-sided score markers (for when scores exceed 50 points). In the bottom right corner, a dial tracks completed rounds.

That is enough to get started.

Preparación de la Partida

1. Place the score tracker in the center of the table with the round dial set to round 1.
2. In a 2/3/4-player game, place 15/18/21 dice of each color into the bag. Return unused dice to the box.
3. Place one more ambulance card than the number of players (always starting with ambulance 1 and continuing in numerical order). Return remaining ambulance cards to the box.
4. Shuffle the department tiles and form a facedown stack. Then, reveal as many tiles as the number of players minus 1.
5. Shuffle the specialist cards and form a facedown deck. Then, reveal as many cards as the number of players minus 1.
6. Create a general supply with the meeples, blood bag tokens, and fatality tokens.
7. Each player chooses a color and receives: a hospital board, 3 white meeples, and 3 dice drawn randomly from the bag. Set these dice to values 3, 4, and 5 (the player chooses which value goes to which die).
8. Shuffle the administrator cards and deal 2 to each player; each player keeps 1 and discards the other.
9. Finally, randomly determine the first player.
   • In a 2-player game, the first player must decide whether to reveal a second department tile or a second specialist card.

We are ready to begin!

Game Flow

A game of Dice Hospital is played over 8 rounds. Each round is divided into 6 phases.

Phase I: Patient Intake

Draw three dice per ambulance from the bag and roll them all. Any dice showing a 1 or 6 must be rerolled until no 1s or 6s remain. Then, place the dice onto the ambulances in ascending order of value (from 2 up to 5). If there are more dice of a specific value than available spots on an ambulance, the player to the right of the first player decides which colored dice are placed among those tied in value.

Then, starting with the first player and proceeding clockwise, each player drafts an ambulance and moves its 3 patients to their hospital. The only restriction is that the first player cannot draft ambulance number 1.

If a player does not have enough room in their wards to accommodate the three incoming patients, they must lose existing patients to the morgue.

The player who drafted the lowest-numbered ambulance becomes the new first player and receives a blood bag token.

Phase II: Hospital Improvements

In ascending order of their chosen ambulances, players select either an available department tile or a specialist card and add it to their hospital. Players may select duplicates of items already in their hospital.

Phase III: Hospital Activation

Now, played simultaneously (though it can be played turn by turn), players activate their hospitals by assigning nurses and specialists to departments to treat their dice. Two rules must be followed:

• Each meeple can only be used once per round.
• Each department can only be activated once per round (it can only hold one meeple).

Each time a patient is treated, its value increases by the amount indicated by the department and/or specialist. Whenever a patient is treated, it is shifted down to the lower section of its bed space to indicate it has received treatment this round. A single die can receive multiple treatments in the same round.

When a die with a value of 6 is treated, it is moved to the discharged area.

Blood bags can be spent during this phase in two ways:

• Directly treat a die, increasing its value by 1.
• Temporarily change a die’s color when activating certain departments. Place the blood bag on the die to show its color has changed for the remainder of the phase.

The phase ends once all players have finished activating their departments.

Phase IV: Neglected Patients

Patients who were not treated this round deteriorate, reducing their value by 1. If a die is already at value 1, the patient dies and is moved to the morgue.

Certain administrators prevent specific patient types from deteriorating.

Phase V: Discharged Patients

• Players score 1/3/5/7/9/11/14/17/21/25/30/35 points for discharging 1/2/3/4/5/6/7/8/9/10/11/12 patients this round (some administrators award bonus points for specific types of discharged patients).
• Players with no remaining patients in their hospital score 5 bonus points.
• For each deceased patient in the morgue, the player takes a fatality token.

After scoring, all discharged and deceased dice are returned to the bag.

Phase VI: Shift Change

Perform the following cleanup steps:

• Return all nurses to the Staff Lounge.
• Return specialists to their respective cards.
• Shift all treated patients remaining in the hospital back to the upper position of their ward spaces.
• Return ambulance cards to the center of the table.
• Advance the round dial.
• Discard unclaimed department tiles and specialist cards to their respective discard piles.
• Reveal new department tiles and specialist cards as done during setup.
• In a 2-player game, the first player chooses whether to reveal a second department or specialist.

A new round then begins.

Game End

The game ends after the eighth round. Players adjust their scores as follows:

• Lose 2 points per fatality token.
• Gain 1 point per unused blood bag token in their personal supply.

The player with the most victory points wins. In case of a tie, the player with the fewest remaining patients in their hospital wins. If still tied, the player whose remaining patients have the highest combined value wins. If a tie persists, players share the victory.

Variants

• Events: Uses the event deck. At the start of the game, shuffle these cards and draw 7 to form a small deck. Starting in round two, reveal the top event card at the beginning of each round and apply its effect.

• Hard Mode (Crisis): Players start with 5 dice instead of 3, configured with values 3-3-4-5-5.
• National Epidemic: When drafting an ambulance, players also draw a fourth die from the bag and roll it for its value (rerolling 1s or 6s).
• Supervirus: During the neglected patients phase, untreated patients drop by 2 points instead of 1.
• Referrals (Derivations): After finishing the final round, follow these steps:
  • Return all ambulances to the center of the table, removing the highest-numbered one (leaving as many ambulances as players).
  • Flip the ambulance cards to their numbered sides.
  • Starting with the current first player and going clockwise, players may transfer a remaining patient from their hospital to a matching color and value slot on an ambulance. Each transferred patient scores 1 point.
  • If a player cannot move any more patients, they pass and take no further turns.
  • Continue until all ambulances are full or all players have passed.
  • Finally, proceed to final scoring, noting that players lose 1 point for every patient remaining in their hospital.

• Solo Mode: Uses medical reports, which are specific criteria to meet regarding discharged patients. At setup, reveal 6 cards in a two-row supply, with only the bottom row available. At game end, the penalty for fatalities is doubled, and players lose 2 points for each uncompleted medical report.

Opinión Personal

I have mentioned this several times in my gaming chronicles: certain strategy games (both real-time and turn-based) left a huge mark on my childhood and, in a way, shaped my taste for management games. In the context of today’s review, one must remember Bullfrog Productions, founded by the legendary Peter Molyneux. They delivered absolute gems like Theme Park (a clear influence on Steam Park), Dungeon Keeper (evidently on Vlaada Chvátil’s mind when designing Dungeon Lords), and, of course, Theme Hospital. I spent countless hours expanding and managing hospitals, trying to contain epidemics and researching cures for hilariously lethal diseases. That is why I held high hopes that Dice Hospital would capture a slice of the soul of that outstanding management video game. Let us see if those hopes were fulfilled, but not before thanking Maldito Games for the review copy that made this tocho-review possible.

In Dice Hospital, we step into the shoes of hospital administrators managing departments, nurses, and specialist doctors. Our goal? Organize our staff and available ward space to treat patients, getting them healthy enough for discharge as quickly as possible to free up beds for incoming admissions. These patients are represented by standard six-sided dice, where the face value denotes health. A die showing a six is nearly cured, while a die showing a one has one foot in the grave. Over the eight rounds of the game, we will juggle available nurses and doctors to treat as many patients as possible, aiming to discharge them in large batches, as this is our primary scoring engine.

The core mechanisms revolve around drafting and action point allowance / worker activation. The game starts with a small group of admitted patients, supplemented each round by those arriving in ambulances. Drafting an ambulance is the first action of every round after rolling and sorting incoming dice across the vehicles in ascending order. This represents one of the few critical decision points in the game, heavily influencing the actions we can take later. On one hand, higher-numbered ambulances carry healthier patients. On the other hand, taking the ambulance with the sickest patients awards a blood bag token, providing valuable flexibility when activating departments.

Drafting the lowest ambulance also secures the first player token, which is crucial for the improvement phase where players draft hospital upgrades—either a new department tile (allowing more effective treatments under specific conditions) or a specialist card (which, along with a color- or value-based ability, adds an extra worker to activate rooms).

Finally, we reach the main phase where players simultaneously and independently run their hospitals, sequencing department activations to treat patients, discharge them, or at least keep them from dying. Each available meeple activates one department. At the end of the shift, players score points for discharged patients along an exponential scale: the first patient awards one point, the next five award two points each, the following two award four points, and so on.

This is where the juggling act comes in. Discharging patients in massive waves is vastly more lucrative than letting them trickle out. Discharging zero patients for two rounds only to release seven or eight at once pays off far better than clearing beds in sets of two or three. The puzzle is clear from the start: balance treatments across the board so patients reach full health concurrently. It feels very much like a spinning plate routine at the circus, keeping multiple plates spinning and focusing attention on the ones about to lose momentum. It makes for an engaging, enjoyable puzzle.

The issue lies in everything surrounding that puzzle. The most significant drawback of Dice Hospital is an alarming lack of player interaction. Some might argue that this is standard for Eurogames, citing classics like The Castles of Burgundy (tocho-review here). In Burgundy, players build on personal boards, yet the shared draft pool, turn order, and timing make competition over tiles vital. That sense of tension and crucial decision-making is virtually absent in Dice Hospital.

While an opponent might draft an ambulance you had your eye on, you are still just taking three dice to manage. Some rounds they fit your setup better, some worse. Drafting is also heavily dictated by turn order: if you go last, you simply take whatever is left. Ultimately, deciding whether to draft the lowest ambulance is more about securing the blood bag and first-player initiative than about the patients themselves.

The same applies to hospital upgrades. Most improvements are roughly balanced in power; you simply pick whichever matches the colors or values you currently lack. You rarely feel genuinely thwarted if an opponent drafts a specific tile or specialist before you, as all options are decent and serve comparable roles.

Compounding this is the fact that the base game is remarkably easy. You start with three patients and receive three per round. If you failed to discharge a single patient during the first three rounds, you would only run out of space at the start of round four—and even then, only if you pushed your luck too hard rather than running out of viable moves. Keeping the emergency room running smoothly is quite manageable with steady discharges.

To inject real tension, you have to turn to the included variants, which stand out as one of the game’s best features. Starting with more dice or doubling the deterioration rate of untreated patients genuinely ramps up the pressure of an epidemic, causing patients to flatline without giving you an easy way out. The goal shifts to simply minimizing casualties. An event deck is also included, though most events provide positive effects that benefit all players fairly equally.

The primary upside of this multiplayer solitaire nature is that the game scales effortlessly. The experience is virtually identical at two or four players. While there are more choices at higher player counts, the differences between available options are minor enough that whether there are three or five ambulances makes little impact.

Conversely, replayability suffers. While the individual puzzle is neat, interest wanes quickly even when ramping up the difficulty. And, as regular readers know, multiplayer solitaire designs rarely rank high on this blog. On the bright side, downtime is practically nonexistent and games play quickly—unless you are paired with an analysis-paralysis titan who takes three times as long to sequence their hospital activations.

A couple of tweaks could have elevated Dice Hospital into a richer experience—such as implementing a worker placement system reminiscent of Russian Railroads (tocho-review here), featuring central shared action spaces alongside hireable specialists (like engineers) that unlock private actions. Alternatively, an action allowing players to refer patients to rival hospitals could have worked wonders. Both concepts would inject meaningful interaction and timing dilemmas to extend the game’s longevity.

Production-wise, the game’s crowdfunding origins shine through. The dice are quality (dense with sharper edges so they do not roll all over the board), cards feature good core weight, linen finish, and excellent snap, cardboard punchboards are thick and pop out cleanly, and the custom wooden meeples (holding tiny pill bottles and syringes) are delightful. The rulebook is clearly structured and unambiguous, though key details—like rerolling 1s and 6s during intake or scoring bonus points for an empty hospital—could be highlighted more prominently to prevent missed rules.

Sebastián Koziner and Sabrina Miramon deliver an art style evocative of classic hospital management sims, particularly on the room tiles (absurd ailments excluded). The cover is eye-catching, and small touches like designing specialist cards to resemble staff ID badges complete with barcodes add great flavor.

And let’s wrap this up. Dice Hospital is a light-medium (leaning very light) game driven by action point allocation to activate hospital departments and treat patients represented by dice. It offers a solid personal puzzle that ultimately falls short. It fits well for casual or family groups looking for an accessible, well-produced, and visually charming game. However, its staying power fades after just a few plays. It does not suffer from major design flaws, but the spark that makes it stand out wears off far too quickly. For all these reasons, I give it a…