We estimate the annual level of investment subsidies for northrhine-westfalian hospitals that is required to maintain and modernize hospital property. Additionally we estimate the funding gap as well as the accumulated investment backlog. The level of required investment subsidies amounts to a level of 1,27 to 1,85 billion Euro, depending on the method of calculation. That results in a funding gap of between 645 bis 917 Mio. €. However, this calculation does not take into account the lack of investments in the past resulting in a investment backlog. We estimate that this investment backlog for NRW amounts to 8,1 billion Euro (residual book value) respectively 13,8 billion Euro (value at acquisition).