# Medical Gas Pipeline Systems Market

> A 2023 WHO resolution turned oxygen into a national plan; medical gas pipeline systems grow from USD 2.86 billion to USD 5.41 billion by 2035.

Publisher: Douglas Insights  
Author: Douglas Insights Research Desk  
Report code: DI-HC-10126  
Published: 2026-09-20  
Last updated: 2026-10-19  
Next review: Sep 2027  
Page: https://www.douglasinsights.com/medical-gas-pipeline-systems-market/

## Key figures

| Measure | Value | How it is built |
| --- | --- | --- |
| Market size · 2025 | $2.86 Bn | Bottom-up: about 14,000 projects at USD 204,000 average project value. |
| Forecast · 2035 | $5.41 Bn | Each 1-point change in project volume growth moves the 2035 figure by roughly USD 510 million. |
| Revenue CAGR · 2026–2035 | 6.60% | Projects from healthcare construction; value from generation plant and monitoring content. |
| Dated event | 30 May 2023 oxygen resolution | The Seventy-sixth World Health Assembly adopted resolution WHA76.3 on 30 May 2023, urging costed national medical oxygen plans and the integration of medical gas systems into health-care construction. |
| Leading element | Distribution pipework and valves | Labour dominated: certified brazing, purging, testing and verification take an estimated 61% of project hours. |
| Fastest segment | Source plant and generation, 8.06% a year | A costed national oxygen plan specifies on-site production rather than a tanker contract. |
| Fastest region | Middle East, 8.34% a year | Gulf hospital programmes specify generation and redundancy as standard. |
| Leader share | Air Liquide ~14% | Air Liquide holds about 14% and the three largest suppliers about 34% of 2025 revenue. |
| Largest region | Asia Pacific | Extensive hospital construction plus public investment in oxygen capacity. |

## Key takeaways

- Douglas Insights values the medical gas pipeline systems market at USD 2.86 billion in 2025 and forecasts USD 5.41 billion by 2035, at 6.60% a year.
- Resolution WHA76.3 of 30 May 2023 urged costed national oxygen plans, and 41 have been drafted since.
- Distribution pipework and valves lead at 40%; source plant and generation grows fastest at 8.06% a year.
- Asia Pacific holds 34% of revenue; the Middle East grows fastest at 8.34% a year.
- On-site generation was specified in 62% of new hospital projects in 2025 against 29% in 2019.

Oxygen stopped being a purchasing line and became a health-system plan on 30 May 2023, when the Seventy-sixth World Health Assembly adopted resolution WHA76.3 and urged every member state to write a costed national medical oxygen plan and to build medical gas systems into health-care construction rather than bolt them on afterwards. Douglas Insights values the medical gas pipeline systems market at USD 2.86 billion in 2025 and forecasts USD 5.41 billion by 2035, compounding at 6.60% a year. The receipt is about 14,000 hospital projects completed in 2025 multiplied by an average project value of USD 204,000, giving USD 2.86 billion, across new build installations, department expansions and system replacements covering source plant, distribution pipework, manifolds, alarms, valves and terminal units, triangulated against hospital construction activity, manufacturer disclosures and contractor reporting. Project volume grows 3.8% a year as healthcare construction advances, while average project value rises 2.7% a year as oxygen plant capacity, monitoring and compliance content increase per installation. This study sits within our [hospital infrastructure](https://www.douglasinsights.com/industry/hospital-infrastructure/) coverage and follows the published [Douglas Insights methodology](https://www.douglasinsights.com/research-methodology/).

## What did the 2023 World Health Assembly oxygen resolution change for medical gas pipeline systems?

Resolution WHA76.3 moved medical gas pipeline systems from a building service into a health-planning instrument, and that changes who signs the cheque.

The [Seventy-sixth World Health Assembly](https://apps.who.int/gb/ebwha/pdf_files/WHA76/A76_R3-en.pdf) adopted it under agenda item 13.1 on 30 May 2023, urging member states to develop costed national plans for quality-assured, affordable medical oxygen systems, to consider stepwise integration of medical oxygen and other medical gas systems into health-care infrastructure construction, and to provide qualified engineers to set up, operate and maintain that infrastructure. Douglas Insights counts 41 national oxygen scale-up plans drafted since the resolution, and models the funding attached at USD 310 million to USD 520 million of pipeline and generation work a year through 2030, concentrated in the Middle East, Africa and South and Southeast Asia. Two effects follow. Generation content rises, because a costed national plan specifies on-site production rather than a tanker contract, which is why source plant grows fastest at 8.06% a year. And the engineer clause matters commercially: a hospital staffing a competent person for medical gases buys maintenance and verification with the installation, lifting attached service revenue by an estimated 18% to 26% of project value.

## Which parts of a hospital's medical gas pipeline systems does this study count?

Four elements of medical gas pipeline systems are counted. Source plant and generation covers pressure swing adsorption oxygen plant, medical air and vacuum plant, cylinder manifolds and liquid oxygen vessel installations with their controls, worth USD 913.9 million in 2025.

Medical vacuum, surgical air for powered surgical tools and anaesthetic gas scavenging systems are counted inside source plant and distribution, because they share the same plant rooms, pipework and alarms as the oxygen and medical air services. Distribution pipework and valves covers degreased copper or stainless pipework, area valve service units, zone isolation valves and the brazing and testing labour that consumes most installation hours, worth USD 1.14 billion. Terminal units and outlets covers bedside and theatre outlets, gas-specific connection points, pendants and bed head trunking supplied with the gas system, worth USD 457.0 million. Alarms, monitoring and controls covers master and area alarm panels, pressure and purity sensing and networked plant monitoring, worth USD 342.7 million. Portable cylinders and their contents, the gases themselves as a consumable, anaesthetic machines, ventilators, the general compressed air equipment sized in our [Industrial Air Compressors Market](https://www.douglasinsights.com/industrial-air-compressors-market/) report and the humidification devices covered in our [Hospital and Healthcare Humidifiers Market](https://www.douglasinsights.com/hospital-and-healthcare-humidifiers-market/) report sit outside the boundary.

## Why did a pandemic turn every hospital into an oxygen producer?

Medical gas pipeline systems changed shape because a logistics dependency failed in public. Before 2020 most hospitals outside the largest facilities took oxygen as liquid delivered by tanker, or in cylinders, and the chain was reliable enough that few questioned it.

When demand rose three to eight times within weeks across whole countries at once, tanker fleets could not deliver, liquid oxygen became a rationing exercise, and hospitals ran critically short while patients needed 40 to 60 litres a minute of high-flow therapy each. The lesson was that pressure swing adsorption plant, which makes oxygen from ambient air, converts a logistics dependency into an electrical one, and electricity is easier to secure in an emergency than a tanker slot. Procurement followed: Douglas Insights counts more than 4,300 oxygen generation plants funded by governments and development banks between 2020 and 2025, and models on-site generation specified in 62% of new hospital projects in 2025 against 29% in 2019. The effect on medical gas pipeline systems is a permanent shift in content toward the generation end, which is why average project value grows 2.7% a year against 3.8% for project count.

## Why is a hospital buying generation capacity it once bought by tanker?

Hospital construction is the first driver of medical gas pipeline systems. New hospitals, critical care expansions and theatre suites all require complete installations, and Douglas Insights counts about 14,000 qualifying projects in 2025 of which roughly 5,200 are new build, each carrying 40 to 900 terminal positions at USD 340 to USD 680 fitted per position.

Resilience investment is the second driver and the one WHA76.3 accelerates. Health systems that ran short of oxygen are funding generation capacity, redundant plant, larger reserve storage and monitoring, which raises content per facility with no increase in bed numbers. Douglas Insights models dual generation plant with reserve manifolds at USD 180,000 to USD 640,000 per hospital, roughly doubling the cost of a single train, and attributes 1.6 of the 2.7 points of annual project value growth to it.

Ageing system replacement is the third driver. Pipeline installations from the 1970s and 1980s are reaching end of life, no longer meet current standards and cannot be verified to modern requirements. Douglas Insights estimates 38% of hospital beds in North America and Europe sit on pipework older than 35 years, and prices replacement at 1.8 to 2.4 times the equivalent new-build work because of phasing and temporary supply, which puts the replacement backlog at roughly USD 4.2 billion of deferred work across the two regions.

Emerging-market capacity building is the fourth driver. Hospital construction across Asia, the Middle East, Africa and Latin America is adding facilities that need complete medical gas pipeline systems, frequently with generation specified from the outset. The Middle East grows 8.34% a year and Africa 7.94%, against 4.94% in Europe, and Douglas Insights counts about 3,900 of the 14,000 projects in 2025 outside the mature markets, at an average value 42% below the North American figure but rising twice as fast.

Certified labour supply is the fifth driver, and it works on price rather than volume: brazing, testing and verification require certified technicians whose numbers grow 2% to 4% a year against project demand of 3.8%, so labour rates rise faster than materials and Douglas Insights carries 0.6 of the 2.7 points of value growth as labour inflation rather than content.

## What holds back a hospital from replacing forty-year-old pipework?

Healthcare capital budgets hold back medical gas pipeline systems first. Hospital construction is funded by governments, insurers and non-profit systems under fiscal pressure, and Douglas Insights observes medical gas packages deferred or descoped in 12% to 20% of projects when a building programme slips, because the gas work follows the building it sits within.

Certified labour scarcity holds it back second: the authorised person and competent person roles for medical gases take 3 to 6 years to train into, and a market can only execute as many projects as its certified bench allows, whatever the demand. Live facility constraints hold it back third and most expensively: replacing pipework in an operating hospital requires temporary supplies, ward decants and night working that Douglas Insights costs at 1.8 to 2.4 times an equivalent empty-building job, which is why hospitals defer until failure forces the work. Emergency replacement then costs 3 to 5 times a planned programme. Undocumented modification holds it back fourth: drawings of a forty-year-old system are rarely accurate, so the pipework must be traced physically before it can be priced, and that survey alone runs USD 15,000 to USD 60,000 on a large site.

## Which element carries the value: the pipework, the plant or the alarms?

Distribution pipework and valves carry the most value, at 40% of 2025 revenue, and source plant and generation grows fastest at 8.06% a year, overtaking pipework before 2033. Douglas Insights values the four elements of medical gas pipeline systems as follows.

| System element | Share of 2025 revenue | 2025 value | 2035 value | Growth to 2035 |
| --- | --- | --- | --- | --- |
| Distribution pipework and valves | 40% | USD 1.14 billion | USD 1.95 billion | 5.47% a year |
| Source plant and generation | 32% | USD 913.9 million | USD 1.98 billion | 8.06% a year |
| Terminal units and outlets | 16% | USD 457.0 million | USD 793.2 million | 5.67% a year |
| Alarms, monitoring and controls | 12% | USD 342.7 million | USD 691.1 million | 7.27% a year |

Pipework leads because it is labour dominated. Certified brazing under inert gas purge, pressure testing and verification consume an estimated 61% of project hours, and labour at USD 65 to USD 145 an hour carries the element regardless of how much copper a project uses.

Source plant and generation is the fastest-growing element, compounding 8.06% a year from USD 913.9 million to USD 1.98 billion and from 32% to 36.7% of revenue, because a costed national oxygen plan specifies production rather than delivery, and because redundancy requirements mean two trains where one would once have done.

Alarms and monitoring grow 7.27% to USD 691.1 million as networked plant monitoring replaces panel alarms; terminal units grow slowest at 5.67% to USD 793.2 million, scaling with bed and theatre counts rather than resilience spending.

## Where are medical gas pipeline systems installed, and which region grows fastest?

Asia Pacific installs the most medical gas pipeline systems, 34% of 2025 revenue or USD 971.0 million, growing 7.74% a year to USD 2.05 billion in 2035, on extensive hospital construction in China and India, substantial public investment in oxygen generation after recent shortages, and rapid private hospital development across Southeast Asia.

The Middle East is the fastest-growing region at 8.34% a year, from USD 342.7 million to USD 763.4 million, on major hospital programmes in the Gulf where generation and redundancy are specified as standard. North America holds 26%, USD 742.6 million, at 5.34% to USD 1.25 billion, weighted toward replacement of an ageing installed base at high value per project. Europe holds 22%, USD 628.3 million, at 4.94% to USD 1.02 billion, similarly replacement weighted with the most exacting verification requirements. Latin America contributes USD 114.2 million at 6.54% and Africa USD 57.1 million at 7.94%, the latter driven by donor and development bank funded oxygen projects. Six regional models sum to the global figure, with country tables in the Excel model.

## Who supplies the plant, the pipework and the terminal units?

Industrial gas majors hold the strongest integrated positions in medical gas pipeline systems, and Douglas Insights estimates the three largest suppliers hold about 34% of 2025 revenue, led by Air Liquide at roughly 14%.

Air Liquide Healthcare, Linde Healthcare and Air Products supply the gas and the infrastructure together, which lets them contract for an outcome, cubic metres delivered at a pressure, rather than for equipment, and that bundling is why their share understates their influence over specification. Among equipment specialists, Amico Group, BeaconMedaes now part of Atlas Copco, Ohio Medical, Precision UK and Gentec supply plant, manifolds, alarms and terminal units, with Atlas Copco also supplying the compressor and vacuum technology beneath the plant. Generation specialists including Oxymat, Novair and On Site Gas Systems have gained directly from the shift to on-site production. Installation sits with certified medical gas contractors, who usually own the maintenance and verification relationship afterwards at 4% to 7% of installed value a year. The competitive chapter profiles coverage by element, certifications held by region, verification network and whether each participant sells equipment, installed systems or bundled gas contracts.

## How much does a medical gas pipeline system cost per project and per terminal position?

A medical gas pipeline system costs USD 204,000 per project on average in 2025, or USD 340 to USD 680 per fitted terminal position. Prices span USD 25,000 for a department extension adding a handful of outlets to more than USD 4 million for a new hospital with redundant generation and several hundred terminal positions.

Price follows labour, since certified brazing and verification dominate hours, and the count of gas services and terminal positions rather than floor area, at USD 340 to USD 680 fitted per position. Live-facility replacement carries premiums of 80% to 140% for phasing, temporary supply and out-of-hours working. Generation plant is priced on capacity and redundancy, with dual plant and reserve roughly doubling the cost of a single train. Maintenance and periodic verification contracts follow installation at 4% to 7% of installed value a year, so over a 25-year life they are worth more in aggregate than the original work, which is why contractors bid installation thin. The pricing chapter publishes project value bands by facility type, bed count, gas services provided and new build versus replacement.

## Which scenarios decide whether generation capacity keeps being funded?

Three medical gas pipeline systems scenarios are modelled. The base case carries 3.8% growth in project volume and 2.7% growth in project value for a 6.60% revenue CAGR and USD 5.41 billion in 2035.

The budget-constrained scenario, in which healthcare capital tightens and replacement programmes are deferred once the memory of the shortages fades, sets the legs at 1.8% and 1.4% and lands near USD 3.91 billion. The resilience-investment scenario, in which the national oxygen plans urged by WHA76.3 are funded on schedule and generation and redundancy become standard specification in more markets, sets them at 5.6% and 4.2% and carries the market past USD 7.65 billion. Each 1-point change in project volume growth moves the 2035 figure by roughly USD 510 million. Published estimates run between 5% and 9% a year; the Douglas figure sits mid-band, and the report states which construction assumptions separate the ends.

## Which medical gas pipeline systems standards and certification rules apply?

Three layers govern medical gas pipeline systems: the ISO 7396-1 pipeline standard, medicinal product rules that treat piped gases as drugs, and competency certification for the people who sign a system off. The first is unusually prescriptive for a building service.

Pipeline standards come first: [ISO 7396-1:2016](https://www.iso.org/standard/60061.html), in its third edition, specifies design, installation, performance, testing, commissioning and documentation for pipelines carrying oxygen, nitrous oxide, medical air, carbon dioxide, helium and oxygen mixtures, surgical tool gases and vacuum, covering supply, distribution, controls and alarms, with national codes on top. Medicinal product regulation is second and is what separates this work from industrial pipework: piped medical gases are drugs, and under [21 CFR 201.161](https://www.ecfr.gov/current/title-21/chapter-I/subchapter-C/part-201/subpart-G/section-201.161) a designated medical gas is defined as a drug administered as a gas, with mandatory warning statements, an Rx only symbol and handling warnings on final use containers. Competency certification is third: the standards define the authorised person and competent person roles, and work performed by uncertified personnel is non-compliant regardless of technical quality, which is what protects the specialist contractor base. The regulatory chapter maps these requirements by jurisdiction.

## What makes replacing a live hospital's medical gas pipeline systems so difficult?

The hardest medical gas pipeline systems projects are not the largest but replacement in live facilities, where the hospital cannot close. Douglas Insights costs that work at 1.8 to 2.4 times an equivalent empty-building job, run in 8 to 30 phases over 12 to 36 months.

A ward being reconnected cannot lose oxygen, so the contractor establishes a temporary supply, migrates the ward, verifies the new arrangement and repeats through the building, each of 8 to 30 phases needing its own testing and certification. Patients are decanted to areas the hospital may not have, so work runs in increments over 12 to 36 months. Cross-connection risk rises sharply during transitions, because the hazard is a line labelled one gas connected to another, and a building carrying old and new pipework at once is where such errors occur; Douglas Insights prices that risk at 6% to 11% of contract value. This is why replacement demand converts into revenue slowly, why hospitals defer, and why a failure that forces emergency replacement costs 3 to 5 times a planned programme.

## Douglas Exclusive: the medical gas pipeline systems standards and certification ledger

The medical gas pipeline systems standards and certification ledger is a Douglas Insights compilation and model, not an official register: it is built on the 6 regional models and 4 system elements of this report and converts the rules in force in each into compliant project scope and value.

The ledger sets out, by jurisdiction, the governing standards in force, the gases and pressures they cover, the testing and verification protocols required, the competency certification regimes and who may sign a system off, the medicinal product obligations applied to piped gases and on-site generation, and the inspection cadence required. It converts healthcare construction forecasts into compliant project scope and value by element and region, and Douglas Insights updates it as national oxygen plans and standards move.

## Methodology: how do 14,000 projects add up to USD 2.86 billion in medical gas pipeline systems?

Douglas Insights built the medical gas pipeline systems model bottom-up from projects across 4 elements, 4 facility types and 6 regions: about 14,000 projects in 2025 at USD 204,000 each give USD 2.86 billion.

Construction and refurbishment activity by facility type gave project counts; bed and theatre counts drove terminal positions at 40 to 900 per project; generation specification rates came from 2019 and 2025 tender evidence; installed base age drove replacement; and realised project values came from contractor disclosures reconciled against the healthcare revenue of 7 suppliers. Maintenance attachment is modelled at 4% to 7% a year but reported separately. Portable cylinders, the gases as a consumable, anaesthetic and ventilation equipment and general building services are excluded. The receipts are 14,000 projects times USD 204,000 for 2025, 3.8% project growth and 2.7% value growth to 2035. The next scheduled review of this study is September 2027.

## Market by segment

| Segment | Share | Value |
| --- | --- | --- |
| Distribution pipework and valves | 40% | $1.14 Bn |
| Source plant and generation | 32% | $913.9 Mn |
| Terminal units and outlets | 16% | $457.0 Mn |
| Alarms, monitoring and controls | 12% | $342.7 Mn |

## Market by region (USD million)

| Region | 2025 | 2026 | 2035 | CAGR 2026-2035 |
| --- | --- | --- | --- | --- |
| Global | 2,856 | 3,044 | 5,414.8 | 6.6% |
| Asia Pacific | 971 | 1,046.7 | 2,046.4 | 7.74% |
| North America | 742.6 | 782.7 | 1,249.5 | 5.34% |
| Europe | 628.3 | 659.7 | 1,017.7 | 4.94% |
| Middle East | 342.7 | 371.5 | 763.4 | 8.34% |
| Latin America | 114.2 | 121.7 | 215.2 | 6.54% |
| Africa | 57.1 | 61.7 | 122.6 | 7.94% |

## Dataset

| Series | Value | Unit |
| --- | --- | --- |
| Market size 2025 | 2,856 | USD million |
| Market size 2035 | 5,414.8 | USD million |
| Revenue CAGR 2026-2035 | 6.6 | percent |
| Project CAGR 2026-2035 | 3.8 | percent |
| Project value CAGR 2026-2035 | 2.7 | percent |

## Frequently asked questions

### How big is the medical gas pipeline systems market?

USD 2.86 billion in 2025, on Douglas Insights' bottom-up estimate: about 14,000 projects at USD 204,000 each.

### How fast are medical gas pipeline systems growing?

6.60% a year, reaching USD 5.41 billion by 2035; 3.8 points from project volume and 2.7 points from project value.

### Which part of a medical gas pipeline system costs most?

Distribution pipework and valves, at 40% of 2025 revenue, USD 1.14 billion, because certified labour dominates project hours.

### Which segment grows fastest, and why?

Source plant and generation, compounding 8.06% a year from USD 913.9 million to USD 1.98 billion, because costed national oxygen plans specify on-site production rather than tanker delivery.

### Where are medical gas pipeline systems installed?

Asia Pacific holds 34% of revenue, USD 971.0 million; the Middle East grows fastest at 8.34% a year to USD 763.4 million.

### Who supplies medical gas pipeline systems?

Air Liquide leads at roughly 14%, with the three largest on about 34%; Linde, Air Products, Amico, BeaconMedaes, Ohio Medical, Atlas Copco, Oxymat and Novair follow.

### What did the 2023 World Health Assembly resolution require?

Resolution WHA76.3, adopted on 30 May 2023, urged member states to write costed national medical oxygen plans and to build medical gas systems into health-care construction.

### What does the licence include?

The full PDF report, the editable Excel model, the Douglas Exclusive standards and certification ledger, a briefing call and the next edition at no extra charge.

## Sources

- [World Health Organization, Resolution WHA76.3, Increasing access to medical oxygen, Seventy-sixth World Health Assembly](https://apps.who.int/gb/ebwha/pdf_files/WHA76/A76_R3-en.pdf)
- [International Organization for Standardization, ISO 7396-1:2016, Medical gas pipeline systems, Part 1: Pipeline systems for compressed medical gases and vacuum](https://www.iso.org/standard/60061.html)
- [US Government Publishing Office, eCFR, 21 CFR 201.161, Medical gases](https://www.ecfr.gov/current/title-21/chapter-I/subchapter-C/part-201/subpart-G/section-201.161)

## How to cite

Douglas Insights, "Medical Gas Pipeline Systems Market", DI-HC-10126, updated 2026-10-19, https://www.douglasinsights.com/medical-gas-pipeline-systems-market/