PPPs in healthcare: Models, lessons and trends for the future


About the report

This report assessed the spectrum of facility-based healthcare public-private partnerships (PPPs) implemented globally to develop a typology of common PPP business models. Drawing on research and findings from prior reports in the UCSF Global Health Group/PwC PPP report series and other sources, this report looks closely at cases highlighted in the series to identify leading practices and innovations in healthcare PPPs to develop supporting criteria for successful implementation.

Key characteristics of PPP models

Features of common PPP models in healthcare

Historically, governments have engaged the private sector to deliver services through healthcare PPPs to achieve one or more of six functions:

  • Finance – financing or co–financing of the project
  • Design – design of the project, including design of the infrastructure and care delivery model
  • Build – construction or renovation of facilities included in the project
  • Maintain – maintenance of hard infrastructure (facilities as well as equipment as applicable)
  • Operate – supply of applicable equipment, IT and management/delivery of nonclinical services
  • Deliver – delivery and management of specified clinical and clinical support services

The majority of facility–based PPPs bundle these functions into three models:

  1. Infrastructure–based model – to build or refurbish public healthcare infrastructure
  2. Discrete Clinical Services model – to add or expand service delivery capacity
  3. Integrated PPP model – to provide a comprehensive package of infrastructure and service delivery

The future of PPPs in healthcare

Looking ahead, healthcare systems will be under ongoing pressure to increase quality and efficiency of care, and find new ways to use data, systems and distributed networks of providers focused more on wellness and disease prevention rather than on the acutely ill. Health systems will need to become more integrated, addressing care needs across the continuum, while utilizing technology to enhance delivery.

PPP models are adapting to these changes. Where early PPPs focused on building and replacing critically-needed hospital infrastructure, integrated PPPs were the next evolution, adding clinical service delivery and private sector management practices to improve the quality of care delivered, as well as access to specialty care.

Focus of most healthcare PPPs today
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