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An article published in the November 2006 issue of the World Health Organization Bulleting concludes that hospitals financed through P3-type schemes are generally more expensive, less flexible, more complicated and of poorer quality than facilities built and operated the traditional way.

The authors - Martin McKee, Nigel Edwards and Rifat Atunc—looked at examples from Australia, Spain, and the United Kingdom. They identify four main issues with P3 hospitals: cost, quality, flexibility and complexity.

New facilities have, in general, been more expensive than they would have been if procured using traditional methods,” they write. “Compared with the traditional system, new facilities are more likely to be built on time and within budget, but this seems often to be at the expense of compromises on quality.”

They also report that the classic P3 emphasis on minimizing risk “means that it is very difficult to “future-proof” facilities in a rapidly changing world”. Finally, they note that “such projects are extremely, and in some cases prohibitively, complex.”

The authors, three British public health policy experts, describe soaring costs at many P3 hospitals. Even more disturbing is the evidence that private contractors cut corners to meet targets, leading to quality issues. At the Cumberland Infirmary in England, for example, we learn of “use of cheap components necessitating regular refitting; maintenance costs 50 per cent higher than projections; poor drainage and plumbing; limited signage; patients leaving the cardiology department must go through five sets of swing doors, even though most are in wheelchairs.”

The lab at another new British P3 hospital flooded three times in its first 18 months, twice with raw sewage, while one mental health facility “was found to have breached every section of the fire safety code.”

The authors are critical of the apparent reluctance to undertake evaluations of P3 hospitals, and say that the debate on the various approaches “has been characterized by ideology rather than evidence.” They also point out similarities between problems in the health sector and well-documented procurement nightmares in the defense sector.

While it is premature to say whether the problems experienced relate to the underlying model or to their implementation, it does seem that a public-private partnership further complicates the already difficult task of building and operating a hospital,” the authors conclude. “The practical results seem not to have lived up to what was expected from privately funded ventures. Uncertainty surrounding the role and value of public-private partnerships in health care needs urgent resolution.”

Go to http://www.who.int/bulletin/volumes/84/11/06-030015.pdf to read the entire article.