Spanish healthcare public private partnerships: The ‘Alzira model’

Journal of Comparative Policy Analysis: Research and Practice, 2015

Road schemes are of major importance in the global PPP market. We focus on Design-Build-Finance-Operate (DBFO) arrangements covered by shadow toll or availability payment mechanisms, where the UK and Spain are key players. Now that a good number of DBFO schemes in the UK and Spain have been operational for well over half the contract period, there is scope for a detailed ex post evaluation of DBFO performance in both countries and an analysis of how the DBFO model has evolved. Preliminary results show that these contracts continue to be very expensive for public administrations, especially in the UK, where the financing costs and fee per kilometre are high. On the other hand, they are an easy source of revenue for the parent companies of the concessionaires, where the increased use of subordinated debt rather than equity seeks to reduce risk. However, despite circumventing the controversial hardtolling, some projects in both Spain and the UK present poor outcomes. Several other problems around these projects are identified, including lack of public accountability and transparency or poor governance, raising long-term questions around affordability and opportunities for further study.

Journal of strategic contracting and negotiation, 2016

While some forms of public-private partnerships are a feature of hospital construction and operation in all countries with mixed economies, there is increasing interest in a model in which a public authority contracts with a private company to design, build and operate an entire hospital. Drawing on the experience of countries such as Australia, Spain, and the United Kingdom, this paper reviews the experience with variants of this model. Although experience is still very limited and rigorous evaluations lacking, four issues have emerged: cost, quality, flexibility and complexity. New facilities have, in general, been more expensive than they would have been if procured using traditional methods. Compared with the traditional system, new facilities are more likely to be built on time and within budget, but this seems often to be at the expense of compromises on quality. The need to minimize the risk to the parties means that it is very difficult to "future-proof" facilities in a rapidly changing world. Finally, such projects are extremely, and in some cases prohibitively, complex. While it is premature to say whether the problems experienced relate to the underlying model or to their implementation, it does seem that a public-private partnership further complicates the already difficult task of building and operating a hospital.

Cost Effectiveness and Resource Allocation

Background: In recent decades, many countries have utilized public-private partnership (PPP) as a development initiative to reform their healthcare sectors. The present study examines the feasibility of implementing public-private partnerships for development of hospital services in Shiraz, Iran. Methods: This was a descriptive study of questionnaires carried out on one of Iran's major southern cities (Shiraz) in 2016. Research population comprised of the hospitals affiliated to the Shiraz University of Medical Sciences (SUMS), private hospitals, charities, and healthcare investors. A total of 56 participants were chosen by convenience sampling. Data were collected using a researcher-made questionnaire. The questions` range were defined from 1 to 5. Data analysis was performed in SPSS 21 using the Mann-Whitney test, T test, and Chi square test at 0.05 significance level. Results: The participants from the public sector had a significantly higher level of acquaintance with the concept of PPP and significantly more inclination to participate in such projects (P < 0.05). The mean values of the determinants of successful implementation of PPPs for hospital services were presented from the public and private participants` viewpoints as follows: public sector rated the capacity-creating (2.60 ± 0.39) and the social-cultural (2.58 ± 0.40) component as having a better condition than other determinants however, the private sector rated the financial-capital (2.64 ± 0.46) as the best. Analysis of the mean scores of determinants of implementation of PPP from the viewpoint of public and private sectors showed a significant difference in their views in terms of financial-capital and social-cultural dimensions (P < 0.05). Conclusions: According to the participants, the requirements for implementation of public-private partnerships for hospital services are not properly met. For any progress to be made in this regard, Iranian authorities and policymakers should devise a new platform for attracting private participation and improving hospitals' readiness to engage in PPP projects.

… Pública: 5 y 6 de febrero …, 2009

Public-Private Partnership is expanding rapidly as an alternative for the provision of goods and services by governments. This paper analyses PPP phenomenon and focuses on relevance as regards healthcare services. Methodology is centred on literature review and a detailed description of the Private Finance Initiative in the United Kingdom as a case study. Our findings corroborate a clear predominance of healthcare services provided in recent years through PPP schemes in the UK and in most other European countries as well. We also confirm that in the UK only 2% of capital value of PFI healthcare projects is scored on the departmental balance sheet. Consequently, while better value for money is demonstrated, affordability and budgetary risk must be carefully surveyed. Cautionary risk factors and benefit potentials should be balanced against each other when governments initiate a PPP strategy.

Healthcare PPPs where clinical services as well as infrastructure are delivered by the private sector are coming under the spotlight as governments seek to achieve value for money in health budgets. Existing examples are being reported as successful, however this article urges caution as a closer look at the evidence shows that handing over control of service delivery to the private sector is difficult to monitor and evaluate, carries cost implications which remain largely unquantified and can create additional risk. Global provision of public infrastructure is under increasing scrutiny as governments grapple with rising costs and declining budgets. In this context Public Private Partnerships (PPPs) continue to be attractive to both governments and investors, despite the problems with debt financing caused by the financial crisis. Whilst transport infrastructure remains most popular (PwC 2010), in other sectors the private sector is moving beyond infrastructure to engage with what until recently has remained the preserve of the public sector-the delivery of core public services. Because of their potential size healthcare services are especially attractive. In OECD countries, where health spending as percentage of GDP is expected to increase from 9.9% in 2010 to 14.4% in 2020 (PwC 2010, p9), infrastructure projects represent only 5% of health spending. A shift to also deliver clinical services will open up a significantly wider market worth $68.1 trillion (PwC, 2010, p5). Such a move changes the fundamental nature of the relationship between the public and private sectors, with the public sector becoming just a commissioner of services provided and delivered in full by the private sector. This means that, although the public sector remains responsible for provision,

2016

OBJECTIVE To review the experiences of selected countries in the use of public-private partnership in the provision of hospital services. METHODS This comparative study was conducted in 2015 in Iran. To collect data, valid databases as well as articles, theses, reports and related books in the field of private-sector partnership in hospital services were employed. Using purposive sampling, countries such as the United Kingdom, Spain, Canada, Turkey, Australia and Lesotho, which had successful experiences in the field of application of the public-private partnership in hospital services, were included. Likewise, the only experience in Iran in this field was also reviewed. Studies done between 1980 and 2015 were examined. The results obtained from each country were compared. RESULTS Implementing public-private partnership had great and valuable outcomes and achievements for governmental hospitals. Moreover, clinical and nonclinical service delivery, hospital utilisation and management...

V International Scientific Conference on Economics and Management Researchers Conference Proceedings Book, 2023

International experience shows that potentially effective programs and strategies fail to reach the bottom line because of deficiencies in one or more of the three core functions of the health system (financing, resource generation and service delivery). There is a renewed debate about when, where, how and to what extent the state will intervene or provide this to market forces as required by patients. One of the main issues is increasing the potential for public-private partnerships (PPPs), which are proposed as a solution, and ensuring consistency and balance in defining the roles and basic rights of the partners. The paper analyses the experience of foreign countries on PPP in the health sector. Scientific novelty and originality of the research lies in the fact that there are not many studies in this direction, and in the current state of healthcare in Azerbaijan, it reflects the ways of effective use of public and private sector resources to improve the quality of healthcare services, and it is necessary to formulate the concept, which includes the features, mechanism, and model of PPP in healthcare.

2021

Public Private Partnership (PPP) projects have become popular during the last 30 years due to the need of new infrastructure and/or renewal projects to be built with limited public resources. PPP scheme has been implemented for public infrastructure such as in transportation, energy, and healthcare in developing countries, developed countries focused on renewals and improvements. Although developed countries have an extensive knowledge in healthcare PPPs, developing countries have been procuring large-scale hospitals through PPP as a new concept. Hence, the lack of know-how and experience in healthcare PPP implementations in developing countries needs to be fulfilled for a successful implementation. The objective of this research is to identify the key challenges experienced in healthcare PPPs in developing countries. The case study research methodology is used to investigate the experiences of stakeholders in large hospital projects. Structures interviews were conducted to collect both primary and secondary data. The results showed major challenges such as the lack of bankable project agreement, lack of institutional capacity and adequate risk allocation, lack of environmental and social impact assessment, incomplete PPP project medical scope, and the short-term vision in terms of investment. Mitigation strategies were recommended to address those challenges for more successful PPP implementation.

Prompted in part by constrained national budgets, European governments are increasingly partnering with the private sector to underwrite the costs of constructing and operating public hospitals and other health care facilities and delivering services. Through such public-private partnerships, governments hope to avoid up-front capital expenditure and to harness private-sector efficiencies, while private-sector partners aim for a return on investment. Our research indicates that to date, experience with these partnerships has been mixed. Early models of these partnerships – for example, in which a private firm builds a hospital and carries out building maintenance, which we term an “accommodation-only” model – arguably have not met expectations for achieving greater efficiencies at lower costs. Newer models described in this article offer greater opportunities for efficiency gains, but are administratively harder to set up and manage. Given the shortages in public capital for new infrastructure, it seems likely that the attractiveness of these partnerships to European governments will grow. Cite this article as: Full reference: James Barlow, Jens Roehrich and Steve Wright (2013). Europe Sees Mixed Results From Public-Private Partnerships For Building And Managing Health Care Facilities And Services. Health Affairs, 32(1): 146-154.