Public Private Partnership in Hospital. Looking for improvements in efficiency of public investments

Background Public Private Partnerships (PPPs) are contractual agreements between government agencies and private sector, aimed at improving the efficiency of public investments. PPPs have increasingly been adopted in public health to design, build, finance, maintain and operate hospitals. This study was aimed to perform a systematic review and a time trend analysis of published PPP hospital experiences around the world. Methods A systematic literature search was carried out, from 1990 to 2014, by a specific search algorithm through PubMed and Scopus databases and a snowball search. Resulting studies were selected by two reviewers independently according to title, abstract and full text. Inclusion criteria were a PPP applicative experience and a hospital setting. The trend of interest in the scientific community was analyzed by calculating the 5-year average annual publication rate. PRISMA guidelines were adopted for reporting the study results. Results Out of the 519 retrieved studies, 158 were finally selected. Of the latter, 73(46.2%) described experiences from Europe (37 from the UK), 36(22.8%) from Asia (15 from India), 35(22.2%) from North America, 16(10.1%) from Africa, 9(5.7%) from Australia, 6(3.8%) from Latin America. The annual publication average rate was 10.2(range 0–23). The 5-year average annual publication rate steadily increased from 0.4 in the years 1990–1994 to 18.8 in 2010–2014 (p< 0.01), with a steeper increase since 2005– 2009 and a peak of 23 in 2014. Conclusions PPP in hospital setting draws increasing attention from scientific community. Despite a wider adoption in the UK, India and North America, PPP recently spread around the world. The observed time trend could also be related to constraints from the worldwide socio-economic crisis. A further PPP diffusion in public health is foreseeable. PPP outcomes in different economic contexts will highlight its efficacy in hospital management and its potential role in the future economic framework. Key messages The scientific community is showing an increasing interest towards PPP adoption and outcomes as a result of PPP spreading experiences also relatable to socio-economic constraints The adoption of PPP in hospital settings could represent a useful strategy enabling governments to meet their objectives more effectively by improving the efficiency of public investments