IDEAS home Printed from https://ideas.repec.org/a/eee/crpeac/v22y2011i6p533-549.html
   My bibliography  Save this article

Spanish healthcare public private partnerships: The ‘Alzira model’

Author

Listed:
  • Acerete, Basilio
  • Stafford, Anne
  • Stapleton, Pamela

Abstract

Global infrastructure reports suggest that, in the wake of the fiscal crisis, healthcare PPPs are seen as a growing area as governments switch attention to social welfare projects. Spain is unique in having had a PPP hospital in operation for over a decade which is funded through a capitation fee. This paper takes a critical approach to evaluate this project, with our analysis showing that the original project could never have been viable and that the renegotiation of the contract has been costly to the government. Viewing the contract through a financialised lens we can see how this contract has been used to ‘make up’ a market for the private delivery of public healthcare in Spain. We also call into question the role of the Spanish savings banks in financing this type of project, which has now been replicated with further hospitals in Spain and Portugal, as well as in developing countries such as Lesotho.

Suggested Citation

  • Acerete, Basilio & Stafford, Anne & Stapleton, Pamela, 2011. "Spanish healthcare public private partnerships: The ‘Alzira model’," CRITICAL PERSPECTIVES ON ACCOUNTING, Elsevier, vol. 22(6), pages 533-549.
    • Handle: RePEc:eee:crpeac:v:22:y:2011:i:6:p:533-549
    DOI: 10.1016/j.cpa.2011.06.004
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S1045235411000785
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.cpa.2011.06.004?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Darrin Grimsey & Mervyn K. Lewis, 2004. "Public Private Partnerships," Books, Edward Elgar Publishing, number 2438.
    2. Pedro Barros & Xavier Martinez-Giralt, 2009. "Contractual design and PPPs for hospitals: lessons for the Portuguese model," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 10(4), pages 437-453, October.
    3. Darrin Grimsey & Mervyn K. Lewis, 2005. "Are Public Private Partnerships value for money?," Accounting Forum, Taylor & Francis Journals, vol. 29(4), pages 345-378, December.
    4. Monrad Aas, I. H., 1995. "Incentives and financing methods," Health Policy, Elsevier, vol. 34(3), pages 205-220, December.
    5. Jean Shaoul & Anne Stafford & Pam Stapleton, 2008. "The Cost of Using Private Finance to Build, Finance and Operate Hospitals," Public Money & Management, Taylor & Francis Journals, vol. 28(2), pages 101-108, April.
    6. Anne Stafford & Basilio Acerete & Pam Stapleton, 2010. "Making concessions: Political, commercial and regulatory tensions in accounting for European roads PPPs," Accounting and Business Research, Taylor & Francis Journals, vol. 40(5), pages 473-493.
    7. Guillem Lopez‐Casasnovas & Joan Costa‐Font & Ivan Planas, 2005. "Diversity and regional inequalities in the Spanish ‘system of health care services’," Health Economics, John Wiley & Sons, Ltd., vol. 14(S1), pages 221-235, September.
    8. Linda M. English, 2005. "Using public–private partnerships to achieve value for money in the delivery of healthcare in Australia," International Journal of Public Policy, Inderscience Enterprises Ltd, vol. 1(1/2), pages 91-121.
    9. Thompson, Ceri R. & McKee, Martin, 2004. "Financing and planning of public and private not-for-profit hospitals in the European Union," Health Policy, Elsevier, vol. 67(3), pages 281-291, March.
    10. Benito, Bernardino & Montesinos, Vicente & Bastida, Francisco, 2008. "An example of creative accounting in public sector: The private financing of infrastructures in Spain," CRITICAL PERSPECTIVES ON ACCOUNTING, Elsevier, vol. 19(7), pages 963-986.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Gordon Dugle & Stephen Debar Kpinpuo & Benjamin Baisie Ghartey, 2021. "From paper to practice: an exploratory study of policy making and implementation in alternative forms of healthcare public‐private partnership in Ghana," International Journal of Health Planning and Management, Wiley Blackwell, vol. 36(3), pages 866-884, May.
    2. Rocco Palumbo, 2017. "Toward a new conceptualization of health care services to inspire public health. Public national health service as a “common pool of resources”," International Review on Public and Nonprofit Marketing, Springer;International Association of Public and Non-Profit Marketing, vol. 14(3), pages 271-287, September.
    3. Angel L. Meroño-Cerdan & Carolina López-Nicolas, 2013. "Understanding the drivers of organizational innovations," The Service Industries Journal, Taylor & Francis Journals, vol. 33(13-14), pages 1312-1325, October.
    4. Roberto Moro Visconti & Laura Martiniello & Donato Morea & Elisa Gebennini, 2019. "Can Public-Private Partnerships Foster Investment Sustainability in Smart Hospitals?," Sustainability, MDPI, vol. 11(6), pages 1-19, March.
    5. Alonso, José M. & Clifton, Judith & Díaz-Fuentes, Daniel, 2015. "The impact of New Public Management on efficiency: An analysis of Madrid's hospitals," Health Policy, Elsevier, vol. 119(3), pages 333-340.
    6. Burke, Richard & Demirag, Istemi, 2015. "Changing perceptions on PPP games: Demand risk in Irish roads," CRITICAL PERSPECTIVES ON ACCOUNTING, Elsevier, vol. 27(C), pages 189-208.
    7. Giulia Cappellaro & Alberto Ricci, 2017. "PPPs in health and social services: a performance measurement perspective," Public Money & Management, Taylor & Francis Journals, vol. 37(6), pages 417-424, September.
    8. Shen, Jie, 2022. "Universities as financing vehicles of (sub)urbanisation: the development of university towns in Shanghai," Land Use Policy, Elsevier, vol. 112(C).
    9. Marco Remondino, 2018. "Information Technology in Healthcare: HHC-MOTES, a Novel Set of Metrics to Analyse IT Sustainability in Different Areas," Sustainability, MDPI, vol. 10(8), pages 1-20, August.
    10. Dillard, Jesse & Vinnari, Eija, 2017. "A case study of critique: Critical perspectives on critical accounting," CRITICAL PERSPECTIVES ON ACCOUNTING, Elsevier, vol. 43(C), pages 88-109.
    11. Manuel B. Aalbers & Jannes Van Loon & Rodrigo Fernandez, 2017. "The Financialization of A Social Housing Provider," International Journal of Urban and Regional Research, Wiley Blackwell, vol. 41(4), pages 572-587, July.
    12. Peda, Peeter & Vinnari, Eija, 2020. "The discursive legitimation of profit in public-private service delivery," CRITICAL PERSPECTIVES ON ACCOUNTING, Elsevier, vol. 69(C).
    13. Maria Caballer-Tarazona & David Vivas-Consuelo, 2016. "A cost and performance comparison of Public Private Partnership and public hospitals in Spain," Health Economics Review, Springer, vol. 6(1), pages 1-7, December.
    14. Hellowell, Mark, 2013. "PFI redux? Assessing a new model for financing hospitals," Health Policy, Elsevier, vol. 113(1), pages 77-85.
    15. Cervero-Liceras, Francisco & McKee, Martin & Legido-Quigley, Helena, 2015. "The effects of the financial crisis and austerity measures on the Spanish health care system: A qualitative analysis of health professionals’ perceptions in the region of Valencia," Health Policy, Elsevier, vol. 119(1), pages 100-106.
    16. Morales, Jérémy & Sponem, Samuel, 2017. "You too can have a critical perspective! 25 years of Critical Perspectives on Accounting," CRITICAL PERSPECTIVES ON ACCOUNTING, Elsevier, vol. 43(C), pages 149-166.
    17. Thomas Wainwright & Graham Manville, 2017. "Financialization and the third sector: Innovation in social housing bond markets," Environment and Planning A, , vol. 49(4), pages 819-838, April.
    18. Comendeiro-Maaløe, Micaela & Ridao-López, Manuel & Gorgemans, Sophie & Bernal-Delgado, Enrique, 2019. "Public-private partnerships in the Spanish National Health System: The reversion of the Alzira model," Health Policy, Elsevier, vol. 123(4), pages 408-411.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Peda, Peeter & Vinnari, Eija, 2020. "The discursive legitimation of profit in public-private service delivery," CRITICAL PERSPECTIVES ON ACCOUNTING, Elsevier, vol. 69(C).
    2. Josef Jilek, 2024. "Measuring the value of public–private partnership," International Review of Economics, Springer;Happiness Economics and Interpersonal Relations (HEIRS), vol. 71(4), pages 917-932, December.
    3. Cian O'SHEA & Dónal PALCIC & Eoin REEVES, 2019. "Comparing Ppp With Traditional Procurement: The Case Of Schools Procurement In Ireland," Annals of Public and Cooperative Economics, Wiley Blackwell, vol. 90(2), pages 245-267, June.
    4. Rangel, Thais & Manuel Vassallo, José, 2015. "Modeling the effect of contractual incentives on road safety performance," Transport Policy, Elsevier, vol. 40(C), pages 17-23.
    5. Khadaroo, Iqbal, 2008. "The actual evaluation of school PFI bids for value for money in the UK public sector," CRITICAL PERSPECTIVES ON ACCOUNTING, Elsevier, vol. 19(8), pages 1321-1345.
    6. Carmona, Miguel, 2010. "The regulatory function in public-private partnerships for the provision of transport infrastructure," Research in Transportation Economics, Elsevier, vol. 30(1), pages 110-125.
    7. Cepparulo, Alessandra & Eusepi, Giuseppe & Giuriato, Luisa, 2020. "Public finances and Public Private Partnerships in the European Union," MPRA Paper 103918, University Library of Munich, Germany.
    8. Miranda Sarmento, J. & Renneboog, L.D.R., 2014. "Anatomy of Public-Private Partnerships : Their Creation, Financing, and Renegotiations," Other publications TiSEM d276f5b6-49cb-40c7-b83c-1, Tilburg University, School of Economics and Management.
    9. Jing Du & Hongyue Wu & Xianbo Zhao, 2018. "Critical Factors on the Capital Structure of Public–Private Partnership Projects: A Sustainability Perspective," Sustainability, MDPI, vol. 10(6), pages 1-27, June.
    10. Miranda Sarmento, J. & Renneboog, L.D.R., 2014. "The Portuguese Experience with Public-Private Partnerships," Discussion Paper 2014-005, Tilburg University, Center for Economic Research.
    11. Rodrigo Nobre Fernandez & André Carraro & Ronald Otto Hillbrecht, 2016. "Efficiency, cost and benefits in contracts of public-private partnerships [Efficiency, cost and benefits in contracts of public-private partnerships]," Nova Economia, Economics Department, Universidade Federal de Minas Gerais (Brazil), vol. 26(2), pages 369-392, May-Augus.
    12. Veiko LEMBER & Ole Helby PETERSEN & Walter SCHERRER & Robert ÅGREN, 2019. "Understanding The Relationship Between Infrastructure Public‒Private Partnerships And Innovation," Annals of Public and Cooperative Economics, Wiley Blackwell, vol. 90(2), pages 371-391, June.
    13. Alessandra Cepparulo & Giuseppe Eusepi & Luisa Giuriato, 2024. "Public Finance, Fiscal Rules and Public–Private Partnerships: Lessons for Post-COVID-19 Investment Plans," Comparative Economic Studies, Palgrave Macmillan;Association for Comparative Economic Studies, vol. 66(1), pages 191-213, March.
    14. Francesco Campanella & Luana Serino & Teresa Nelli & Domenico Graziano, 2018. "Macroeconomics Effects on Project Finance Performances and Sustainability," International Business Research, Canadian Center of Science and Education, vol. 11(6), pages 21-28, June.
    15. Maria Caballer-Tarazona & David Vivas-Consuelo, 2016. "A cost and performance comparison of Public Private Partnership and public hospitals in Spain," Health Economics Review, Springer, vol. 6(1), pages 1-7, December.
    16. Martijn van den Hurk & Marlies Hueskes, 2017. "Beyond the financial logic: Realizing valuable outcomes in public–private partnerships in Flanders and Ontario," Environment and Planning C, , vol. 35(5), pages 784-808, August.
    17. Maria Caballer-Tarazona & David Vivas-Consuelo, 2016. "Erratum to: ‘A cost and performance comparison of Public Private Partnership and public hospitals in Spain’," Health Economics Review, Springer, vol. 6(1), pages 1-1, December.
    18. Avner Offer, 2018. "Patient and impatient capital: time horizons as market boundaries," Oxford Economic and Social History Working Papers _165, University of Oxford, Department of Economics.
    19. Opara, Michael & Rouse, Paul, 2019. "The perceived efficacy of public-private partnerships: A study from Canada," CRITICAL PERSPECTIVES ON ACCOUNTING, Elsevier, vol. 58(C), pages 77-99.
    20. Fandel, Günter & Giese, Anke & Mohn, Brigitte, 2012. "Measuring synergy effects of a Public Social Private Partnership (PSPP) project," International Journal of Production Economics, Elsevier, vol. 140(2), pages 815-824.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:crpeac:v:22:y:2011:i:6:p:533-549. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: https://www.journals.elsevier.com/critical-perspectives-on-accounting/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.