terça-feira, junho 03, 2014

Evaluation of PPP in Healthcare accross the EU, 2013

Healthcare is universally considered as a public service across all member states, whether a social security insurance system is in place (Bismarck model) or national (welfare) health system funded by general taxes (Beveridge model) is applied. There does not seem to be any definable relationship as between the two health service concepts and the model of PPP adopted. The structure of each deal depends mainly on
the provision of national legislation in terms of law on enterprises, fiscal regulations or procurement models for the public sector and of course political / ideological conviction.

The study has shown that apart from standard PPP legal provisions, specific PPP legislation for the health sector, as such, does not need to be in place – all PPPs in the case studies made use of the existing or updated generic PPP legal frameworks, though some such as Portugal and Italy had specific enabling legislation.

A useful way of categorising and understanding health PPP is in terms of the extent of services covered by the private partner: the concept of bundling the services in the contract of the private partner.

Portugal (PPP in health service is the second biggest market after UK, implemented the integrated hospital twin-SPV-model from 2002 and switched in 2005 to PFI - type infrastructure only contracts);

The Portuguese “twin-SPV” integrated hospital PPP models have less impressive financial than clinical results, so they may not be sustainable (this may be a start-up problem). It is unusually difficult to attract funding for them from international sources, and they are contractually complicated having two contracts, one for the building and another for the clinical services. Their efficiency, however, makes them less problematic for the state than most other sector Portuguese PPP programmes such as transport, because of the use of a disciplined PSC/VfM and contract management process.

See full report, conclusions and recommendations in
Avaliação de Hospitais PPP na Europa, S. Wright, M. Abrantes