Developing sustainable healthcare governance mechanisms to manage public-private partnerships

Abstract

Background: Despite a growing body of research literature focused on public-private partnerships (PPPs) in healthcare, some critical issues still seem to be insufficiently investigated, especially due to the frequent lack of clarity in defining the goals for healthcare management and to an oversimplified framework for analysing PPPs. Resolving conflicts of interest between diverse PPP stakeholders in healthcare requires special attention. Effective solutions in this area are not well known in Central and Eastern Europe countries, which are trying to modernise their healthcare systems. Aims: The purpose of this article is threefold. Firstly, it is to establish an appropriate understanding of healthcare sustainability, currently understood as the ultimate goal for healthcare management. Secondly, it is to shift the context for analysing the performance of PPPs from a purely financial to a wider and well-framed one, comprising the pillars of healthcare sustainability. Thirdly, it is to identify the governance mechanisms intended to improve the impact of PPPs on healthcare sustainability. Methods: The methods employed include a broad conceptual analysis of the international literature as well as external online desk research of the materials published by PPP consortia, financial institutions and public authorities engaged in managing PPPs for healthcare in Europe. Results: Healthcare sustainability is a complex, multifaceted and multi-pillar problem. PPPs can enhance, or damage, all healthcare sustainability pillars due to a complex conflict of interest between the parties involved. Embedding certain governance mechanisms in PPP contracting and management is necessary to foster both financial and nonfinancial sustainability in healthcare provided via PPPs. Some countries and some PPPs have managed to develop suitable mechanisms to govern the conflicting goals in healthcare management. Conclusions: The mechanisms governing PPPs can be programmed as sustainability drivers to improve the resilience of healthcare to the benefit of all stakeholder groups, including capital providers, society and the government. The experiences of PPPs in healthcare operating in the European context may inspire an appropriate design of the PPP framework and PPP contracts. (original abstract)