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When all the patients have been placed into a pool, the game begins. Each round 4 patient pools are bid on. The first player picks a pool of patients by placing the blue patient pawn on the pool of their choosing. After the pool is selected, each player offers a plan card for the patients to occupy. The bids are secret, so cards should be placed with the building side up. When each player has made a bid for the chosen patients, the plan cards are flipped over.
The player with the lowest priced plan takes the patients and puts them on the plan they offered. The player must fill the card with patients from left to right. The order of patients is up to the player.

The patient pawns that are on the red area(s) of the plan will have a claim to be paid.
After the first patient pool has been placed on the winning player’s plan, the player to the left picks a patient pool and the bidding begins again. The selection and bidding process is repeated until each player has had a chance to select a patient pool to bid on. A plan with patients on it cannot be used to bid with.