Since visiting real hospitals is often unpleasant, the emphasis on humour to lighten the mood was deemed important by the developers.

The game was designed and developed by some of the creators of Theme Hospital, including Mark Webley and Gary Carr.

Within weeks of release, Two Point Hospital was the second most downloaded game in the sales charts for Europe, Middle East, Africa, and Australia.

The game was received positively by critics, garnering acclaim for its style, humour and its faithfulness to Theme Hospital's aesthetics, but criticised for its repetitiveness and room design.

The game received seven major updates as downloadable content after its release which added regions and illnesses to cure, as well as four item packs.

Tasks include building rooms and amenities that satisfy the needs (such as hunger and thirst) of patients and staff (such as toilets, staff rooms, reception desks, cafés, seating, and vending machines),[3][7][8] expanding the hospital into new plots, the hiring and management of doctors, nurses, janitors, and assistants to maintain the hospital; and dealing with a variety of comical illnesses.

[30] In April 2019, the "Superbug Initiative" update added co-operative community challenges, featuring numerous goals along progression system.

[39] Their first attempt was ER Tycoon, which was planned during Carr's time at Mucky Foot Productions but was cancelled because they could not find a publisher for the game.

[1][39] Carr said: "I wanted to work on something like Theme Hospital again, appealing to a broader range of people",[1] and Webley stated that they "had been talking about this project for a number of years".

[39] Online features were an early target of the design of Two Point Hospital; Webley and Carr recognised that players of management games tend to prefer single-player experiences.

Players would be tasked with achieving objectives such as curing patients within a set number of months and their scores would be placed on online leaderboards.

However, Microsoft closed Lionhead in April 2016 before the Sega deal was complete and they had to quickly choose their staff on limited funds.

[3] Hymers said that patient queues and their movement along corridors were difficult to develop because the game is in 3D, which raised questions about wall thickness and cell width.

He believed that this was less of an issue in Theme Hospital, which is 2D with graphics made from sprites, and that people were drawn in front of the walls.

[49] Their original intention was to create all the sound effects themselves and not use any samples, but they changed their minds when they saw the machines (which diagnose or treat patients) in the game.

For example, an umbrella, some straws, and a yoghurt drink were used by French to create the sounds for Chromotherapy (a disease which causes patients to turn grey and requires them to be re-coloured).

[51] French stated that the songwriting process began with a guitar or piano riff together with percussion elements (which included bongos and claves).

They recorded many sounds of their own in the studio, for example, French made his own instrument by using PVC bathroom pipes,[48] which was sampled so it could be played on a keyboard.

For one of the radio advertisements, singer Sophie Worsley was hired to sing the lyrics sung by the game's popstar.

[49] Two Point Hospital was announced on 16 January 2018[52] in a short YouTube video showing the game's visuals and comedic styling, and depicted a patient suffering from Light Headedness.

[54] The gameplay demo explored the game's user interface and its turning camera, which was not present in Theme Hospital.

[62] A Halloween patch was released on 23 October 2018, which introduced a "creepier" soundtrack, new DJ lines, a night-time intervention, and the 'Frightheadedness' disease.

[63] A free update in March 2019 added decorative objects based on other game series on Steam, including Total War: Three Kingdoms, Endless Space, Football Manager, and Half-Life 2.

[66][67] The third expansion, "Close Encounters", released on 29 August 2019 adds science fiction elements such as aliens and the mysterious "Chasm 24".

[72] Sega announced in July 2019 that the game will be brought to Nintendo Switch, PlayStation 4, and Xbox One consoles, with all post-release updates that have been added to the personal computer version including the "Bigfoot" expansion, sometime later in 2019.

[22] Game Informer's Ben Reeves thought that Two Point Studios had done "a remarkable job reviving Theme Hospital".

UK newspaper Metro regarded the "amusing script and visual humour" of Two Point Hospital as one of its best features, calling it "endearing".

It just feels comfy, goofy and pleasant ..."[91] James Swinbanks of GameSpot and GamesRadar+'s Rachel Weber echoed these sentiments by complimented the game's British sense of humour.

[24] José Cabrera of IGN Spain was positive about the gameplay, referring to the game as being "fun and light-hearted" and praising its addictiveness[92] along with Asarch.

[11] Fraser Brown of PC Gamer magazine agreed with Hafer, calling it a "brilliant management game, regardless of nostalgia".