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Abstract
BackgroundPublic-private partnerships (PPPs) are potential instruments to enable private collaboration in the health sector. Despite theoretical debate, empirical analyses have thus far tended to focus on the contractual or project dimension, overlooking institutional PPPs, i.e., formal legal entities run by proper corporate-governance mechanisms and jointly owned by public and private parties for the provision of public-health goods. This work aims to fill this gap by carrying out a comparative analysis of the reasons for the adoption of institutional PPPs and the governance and managerial features necessary to establish them as appropriate arrangements for public-health services provisions.MethodsA qualitative analysis is carried out on experiences of institutional PPPs within the Italian National Health Service (Sistema Sanitario Nazionale, SSN). The research question is addressed through a contextual and comparative embedded case study design, assuming the entire population of PPPs (4) currently in force in one Italian region as the unit of analysis: (i) a rehabilitation hospital, (ii), an orthopaedic-centre, (iii) a primary care and ambulatory services facility, and (iv) a health- and social-care facility. Internal validity is guaranteed by the triangulation of sources in the data collection phase, which included archival and interview data.ResultsFour governance and managerial issues were found to be critical in determining the positive performance of the case examined: (i) a strategic market orientation to a specialised service area with sufficient potential demand, (ii) the allocation of public capital assets and the consistent financial involvement of the private partner, (iii) the adoption of private administrative procedures in a regulated setting while guaranteeing the respect of public administration principles, and (iv) clear regulation of the workforce to align the contracts with the organisational culture.ConclusionsFindings suggests that institutional PPPs enable national health services to reap great benefits when introduced as a complement to the traditional public-service provisions for a defined set of services and goals.
Highlights
Public-private partnerships (PPPs) are potential instruments to enable private collaboration in the health sector
The overarching aim of this paper is to investigate the motivations for the adoption of institutional PPPs and the governance and managerial features that could make them effective
cases: (i) an intensive-rehabilitation hospital (Case A), for example, used to be an acute care facility that was forced to close in the 90s when the regional plan gave a nearby hospital exclusive rights to provide general health services
Summary
Public-private partnerships (PPPs) are potential instruments to enable private collaboration in the health sector. Various provision forms have been adopted: in-house production; outsourcing to other public administrations; contracting out of peripheral, intermediate, or final services to private providers; public-private partnerships (PPPs) and full privatisation [1,2]. PPPs have long been considered as the form of provision able to maximise the gains deriving from private production, while preserving the collective goals of the public realm. These hybrid solutions may be rather difficult to design and implement, due to the heterogeneous - and potentially conflicting - missions, goals, organisational cultures and legal frameworks adopted by the partners. The extent to which a PPP may support the public administration in carrying out its functions and in achieving public sector goals depends both on the institutional coherence of the adopted organisational form and the appropriateness of its governance and managerial structure
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