Public Private Partnerships and the Quality and Efficiency of Healthcare Services
Although the use of public private partnerships (PPPs) is endorsed by agencies at the national and supranational levels, there is little guidance for decision-makers on what good outcomes look like and the circumstances in which such outcomes are likely to occur. Enhanced understanding of these issues can improve the governance of large-scale and complex contracting in the health sector. Drawing on a narrative review of the available theoretical and empirical research, this chapter shows that PPPs have the potential to generate a number of benefits, including (i) better investment decisions, (ii) more efficient infrastructure delivery and (iii) higher quality health services. However, PPPs are also associated with additional transaction and financing costs, and may give rise to affordability challenges. And addressing these threats to the public interest requires diligent and competent managerial intervention.
KeywordsPPPs value for money affordability transaction costs finance costs
- de Bettignies, J.-E., & Ross, T. W. (2011). The Economics of Public-Private Partnerships: Some Theoretical Contributions. In G. Hodge, C. Greve, & A. Boardman (Eds.), International Handbook on Public–Private Partnerships. Cheltenham: Edward Elgar.Google Scholar
- Dudkin, G., & Välilä, T. (2005). Transaction Costs in Public-private Partnerships: A First Look at the Evidence, EIB Economic and Financial Report 2005/03. Luxemburg: European Investment Bank.Google Scholar
- Gaffney, D., Pollock, A., Dunnigan, M., & Shaoul, J. (1999). PFI in the NHS: Is There an Economic Case? British Medical Journal, 319, 4116–4119.Google Scholar
- Hellowell, M. (2010). The Private Finance Initiative: Policy, Performance and Prospects. In G. Hodge, C. Greve, & A. Boardman (Eds.), International Handbook on Public–Private Partnerships. Cheltenham: Edward Elgar.Google Scholar
- Hellowell, M. (2015). Analysis: Borrowing to Save: Can NHS Bodies Ease Financial Pressures by Terminating PFI contracts? BMJ. http://www.bmj.com/bmj/section-pdf/903129/6.
- Irving, J., & Manroth, A. (2009). Local Sources of Financing for Infrastructure in Africa. Washington, DC: World Bank.Google Scholar
- Lonsdale, C. (2005). Risk Transfer and the UK Private Finance Initiative: A Theoretical Analysis. Policy and Politics, (2), 231–249.Google Scholar
- McKee, M., Edwards, N., & Atun, R. (2006). Public–private Partnerships for Hospitals. Bulletin of the World Health Organization, 84, 890–896.Google Scholar
- Montagu, D., & Harding, A. (2012). A Zebra or a Painted Horse? Are Hospital PPPs Infrastructure Partnerships with Stripes or a Separate Species? World Hospitals and Health Services, 48(2), 15–19.Google Scholar
- Monteiro, R. (2013). Implementing a Framework for Managing Fiscal Commitments from Public Private Partnerships. Washington, DC: The Financial and Private Sector Development Network.Google Scholar
- National Audit Office. (2015). The Choice of Finance for Capital Investment. Available at: https://www.nao.org.uk/report/the-choice-of-finance-for-capital-investment/. Accessed 19 Mar 2015.
- Pollock, A., Price, D., & Liebe, M. (2011). Private Finance Initiatives During NHS Austerity. BMJ, 342, https://doi.org/10.1136/bmj.d324. National Audit Office.
- Reiss, A. (2005). Is the PPP Model Applicable Across Sectors? EIB Papers, 10(2), 10–30. Luxembourg: European Investment Bank.Google Scholar
- Reviglio, E. (2012). Global Perspectives for Project Financing. Presentation to the Joint EC-EIB/ EPEC Private Sector Forum, Brussels, 6th June.Google Scholar
- Välilä, T. (2005). How Expensive Are Cost Savings? On the Economics of Public-private Partnerships. EIB Papers, 10(1), 94–119. Luxemburg: European Investment Bank.Google Scholar
- Williamson, O. (1985). The Economic Institutions of Capitalism. New York: The Free Press.Google Scholar
- Williamson, O. (1990). Transaction Cost Economics and Organisation Theory. In O. Williamson (Ed.), Organisation Theory: From Chester Barnard to the Present and Beyond. New York: Oxford University Press.Google Scholar
- Yescombe, E. R. (2008). Public-private Partnerships: Principles of Policy and Finance. London: Elsevier Finance.Google Scholar