More than 19 percent of hospitals are in a poor or very poor condition, according to a Treasury report.
In the Southern District Health Board region alone more than 16 percent of hospitals are in a very poor condition according to the Treasury's 2018 Investment Statement, which takes stock of the Crown's assets.
Treasury found improvement was needed in performing scheduled maintenance at hospitals, with a number of DHBs reporting underspending in this area.
Some of these DHBs had net deficits, suggesting that they were deferring repairs and maintenance to direct spending to other areas.
Treasury estimates more than $14 billion will be needed in the next decade to replace or upgrade aging hospital assets.
DHBs are heavily reliant on the Government for additional funding to replace assets, rather than being able to finance them with their own resources.
The report found that despite the health system performing strongly overall, there are "persistent and significant disparities in outcome and access for some population groups".
There was a disparity in acute admissions to hospitals that are considered avoidable through primary or community care.
Māori children were 1.3 times more likely to have an acute admission to hospital than children of other ethnicities, while Pasifika children were 2.3 times more likely.