Do Public-Private Partnerships add value to healthcare delivery?

Background Public Private Partnership (PPPs) are a form of contractual cooperation between a government entity and the private sector. This study was aimed to explore PPPs international models applied in healthcare settings and their impact. Methods A systematic review was performed from 1990 to 2015 through PubMed and Scopus. Resulting studies were analyzed according to title, abstract and full text. Inclusion criteria were the description of a PPP applicative experience and the healthcare setting. A quality assessment of the studies was carried out and the different forms of PPPs and their quantitative, qualitative and/or financial impacts were analyzed. Results Out of the 165 retrieved studies 26 articles were selected, mainly coming from Europe (35%).Twelve articles were identified as good quality. The most described PPP model was “Accommodation only” (38%, p = 0,02). As for quantitative results, 10 articles (37%) described a positive impact (increase of patient admissions and service provisions, reduction of waiting time); however, 5 (19%) stated an evident lack of results. About qualitative analysis, 10 articles showed that PPPs contributed to better quality of care (increase of services and patient satisfaction, development of integrated care); only 2 articles addressed clinical outcomes (infections and mortality decrease). As for financial results, 10 articles described loss of incomes, 3 articles reported an increase in efficiency, while 5 of them reported inconsistent information. Conclusions PPPs have gained growing recognition in public health, especially in Europe. However, there are still deeply heterogeneous data about their benefits/drawbacks in hospital settings. Our work showed that, in a context of crisis for many European health services, a more consistent evaluation of new experiences from a governance perspective could help to build resilience and efficiency for health providers, so that each PPP model could be better adapted to the specific context. Key messages: PPPs are an increasingly widespread form of contracts adopted in healthcare settings, but an assessment of their advantages is still uncertain because of insufficient and heterogeneous data. Future research should focus on PPPs from a governance perspective to help fit each form of contract to a specific setting, in order to promote efficiency and effectiveness of health systems.