Integrating Infrastructure and Clinical Management in PPPs for Health Care

Abstract

The worldwide development of health care infrastructures and services has been increasingly founded on public-private partnerships (PPPs). Led by the benefits of this procurement model, governments felt tempted to engage themselves in long-term contracts for the provision and management of health care facilities, under distinct configuration schemes. Several arrangements have been tried: partnerships concerning just the infrastructure on a stand-alone basis, or bundling infrastructure and clinical services management, among other more unusual models. Experience has demonstrated benefits and pitfalls in each model. This paper tries to overcome the gap in the literature regarding the review of PPP arrangements in a cross-country perspective. Using case studies from 16 countries (10 European Union, Canada, Australia, Chile, Mexico, South Africa, and Lesotho), it provides a reflection on international experiences with health care PPPs and draws some recommendations for further development. To support the discussion on the trade-off between contract complexity and the ability to capture efficiency through vertical integration, the Portuguese case is presented in detail because it represents a unique model. The potential benefits of the integration should not be neglected.