tiltfactor » Bill of Health

Bill of Health

Bill of Health is the captivating medical care strategy game for three to five players. Players must set prices low to attract patients, while still being able to afford to care for them for the duration – no matter what happens. Compete with other health care providers to increase revenue and finance improvements in quality. Should you invest in quick fixes or in better systems and training? Bid wisely, invest strategically, and make your care the best it can be or the next bill will be yours!

Why Bill of Health Matters

Bill of Health is designed to illustrate the concept of capitated payments for health care in the U.S. health care system, and this payment model’s positive effects on health care quality and costs.

Bill of Health supports Aligning Forces for Quality, the Robert Wood Johnson Foundation’s signature effort to lift the overall quality and value of health care in targeted communities, reduce racial and ethnic disparities, and provide models for national reform.

Bill of Health was designed and produced in collaboration with Digital Mill, and made possible with support from the Robert Wood Johnson Foundation (RWJF).

Play Summary

Players take on the role of health care providers trying to stay afloat in changing health care markets. Every round four patient cards with unique health problems come seeking care. Players bid on each patient. The player who bids lowest wins that patient’s business, is paid equal to the value of her bid, and is in charge of taking care of the patient for the rest of the game. Bid low to attract patients, but bid too low and you’ll go broke trying to take care of expensive patients!

Players use the payment from their patients to upgrade their health care infrastructure, unlocking the capacities to treat their patients’ problems more efficiently, and to prevent their patients from developing new problems. Each patient a player has at the end of the game gives her points towards winning – the riskier the patient, the more points he provides – but provides one less point for each health problem remaining. The player who can take the best care of the most patients to get the most points wins!

  • Executive Producer: Mary Flanagan
  • Game Design: Mary Flanagan, Max Seidman, Ben Sawyer, Lucas Sanford-Long, Royce Park, Nick O’Leary
  • Graphic Design: Sarah Ettinger, Zara Downs
  • Production: Max Seidman, Lucas Sanford-Long, Royce Park, J. Patrick Lewis
Warning: In compliance with the Consumer Product Safety Improvement Act of 2008 (CPSIA) we are notifying you that some of the products we sell may contain small parts or parts that may break off potentially causing a choking hazard to small children. Please supervise small children to ensure their safety.


Any opinions, findings, and conclusions or recommendations expressed in this material are those of the authors and do not necessarily reflect the views of the Robert Wood Johnson Foundation.

  • Tiltfactor invents new ways of thinking about important social issues through engaging games and play. Founded and directed by leading innovator Dr. Mary Flanagan, Tiltfactor is the award-winning design studio and research laboratory that takes on problem areas of national need and creates solutions through playful design.