Hospitals

In recent years, a number of countries have aggressively moved to diversify the sources of health care funding by using PPP arrangements to meet the growing demand for health care infrastructure. Typically, a private consortium designs, builds, owns, and operates a hospital and leases it back to the relevant government entity-such as a hospital board-for a period of 20 to 60 years.

Since 1997, 85 percent of funds for major UK National Health Service projects have come under the PFI scheme.54 The total number of PFI hospital projects, 130, dwarfs the 12 publicly funded hospital projects developed during that time. Clinical services and some cleaning and catering-type functions usually remain the responsibility of the public sector, while the private sector builds and operates the facilities. Contract terms are generally 30 to 35 years.

In Portugal, 31 hospitals will be built using PPPs. The entire program, at an estimated cost of $37 billion, should be complete by 2014, with 10 new hospitals launched in 2006.55 The contract covers the design, construction, financing, maintenance, and operation of the facilities as well as hospital management and some clinical services.56 Meanwhile, in Ireland, a survey in 2005 of private infrastructure providers identified hospitals as the sector with the most potential for PPP development: 79 percent of respondents ranked it first on their preference order for PPP development.57