In the healthcare sector, private-public partnerships (PPPs) to Design, Build, Finance and Operate (DBFO) new infrastructures are still expected to increase, due to government spending constraints (Barlow et al., 2013). The... [ view full abstract ]
In the healthcare sector, private-public partnerships (PPPs) to Design, Build, Finance and Operate (DBFO) new infrastructures are still expected to increase, due to government spending constraints (Barlow et al., 2013). The research on PPP in healthcare is rich, but it mainly focuses on financial viability (Roehrich et al., 2014; Torchia et al., 2015). This paper aims to collect exploratory evidence about the specific impact of a PPP-DBFO operation on three additional issues suggested by McKee et al. (2006), but neglected by subsequent research: building’s quality, infrastructure’s flexibility and governance complexity. A better understanding of such elements is expected to offer preliminary explanations about the paradox highlighted by Roehrich et al. (2014): papers on policies draw out PPP advantages, while research on practice emphasizes partnerships’ disadvantages and studies on outcomes are cautious.
Practically, the work investigates: (i) the fulfillment of policymakers’ and hospital managers’ desiderata regarding the quail-quantitative features of the infrastructure, at the moment of the delivery and over time. By the way, the research deepens the absence of private partner’s opportunistic behaviors through the construction of an oversized hospital with higher service fees; (ii) the trade-offs between rigid specification of the hospital characteristics and flexibility issues, given the rapid epidemiologic change; that is, the risk of commissioning a rigid infrastructure, soon becoming an “expensive empty box”; (iii) the PPP infrastructure as a tool reducing, and not only increasing, the complexity of the internal organizational change. Moreover, the paper wants to deepen how partnerships can contribute to reduce external complexity of large-scale change in hospital provision, highlighting interplays with political and social issues.
Since the research focus is unprecedented, the author selected three multi-level, qualitative case studies, to collect abundant preliminary evidence, enable comparisons and develop conceptual arguments (Eisenhardt, 1989; Yin, 2003). The research deepens three regional contexts within the Italian National Health System, exploring variations between policy approaches, large-scale outcomes, managerial practices and local achievements. The data collection technique included semi-structured, in-depth interviews with 6 regional officers and 11 with hospital managers, triangulated with documentary evidence. Interviews’ transcripts were analyzed using the software Atlas.ti.
Even though the financial dimension of the PPPs remains critical, the research findings highlight a number of additional, relevant evaluative elements. On the whole, PPPs looks like a potential shortcut for policymakers and public managers seeking for their strategic (policy) goals when the budget constraint is restrictive. If the public partner is experienced enough to cope with a laborious practice, the PPP can help to achieve notable social and political outcomes, even though scholars should deepen their actual range. A general recommendation is to create knowledge networks to share the know-how in planning and managing PPPs.
The author, MSc, 29, is contracted Research Fellow at CERGAS (Centre for Research on Healthcare and Social Care Management) of Bocconi University (Milan, Italy). He is also PhD candidate at Milan’s Catholic University (Management program). His main research interests are: trends of the Italian Welfare system; assessment of PPPs in the healthcare sector; managerial accounting and performance management.
