IDEAS home Printed from https://ideas.repec.org/a/eee/hepoli/v113y2013i1p77-85.html
   My bibliography  Save this article

PFI redux? Assessing a new model for financing hospitals

Author

Listed:
  • Hellowell, Mark

Abstract

There is a growing need for investments in hospital facilities to improve the efficiency and quality of health services. In recent years, publicly financed hospital organisations in many countries have utilised private finance arrangements, variously called private finance initiatives (PFIs), public–private partnerships (PPPs) or P3s, to address their capital requirements. However, such projects have become more difficult to implement since the onset of the global financial crisis, which has led to a reduction in the supply of debt capital and an increase in its price. In December 2012, the government of the United Kingdom outlined a comprehensive set of reforms to the private finance model in order to revive this important source of capital for hospital investments. This article provides a critical assessment of the ‘Private Finance 2’ reforms, focusing on their likely impact on the supply and cost of capital. It concludes that constraints in supply are likely to continue, in part due to regulatory constraints facing both commercial banks and institutional investors, while the cost of capital is likely to increase, at least in the short term.

Suggested Citation

  • Hellowell, Mark, 2013. "PFI redux? Assessing a new model for financing hospitals," Health Policy, Elsevier, vol. 113(1), pages 77-85.
  • Handle: RePEc:eee:hepoli:v:113:y:2013:i:1:p:77-85
    DOI: 10.1016/j.healthpol.2013.09.008
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0168851013002339
    Download Restriction: Full text for ScienceDirect subscribers only

    File URL: https://libkey.io/10.1016/j.healthpol.2013.09.008?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. Bennett, John & Iossa, Elisabetta, 2006. "Building and managing facilities for public services," Journal of Public Economics, Elsevier, vol. 90(10-11), pages 2143-2160, November.
    2. Thompson, Ceri R. & McKee, Martin, 2011. "An analysis of hospital capital planning and financing in three European countries: Using the principal-agent approach to identify the potential for economic problems," Health Policy, Elsevier, vol. 99(2), pages 158-166, February.
    3. Elisabetta Iossa & David Martimort, 2012. "Risk allocation and the costs and benefits of public--private partnerships," RAND Journal of Economics, RAND Corporation, vol. 43(3), pages 442-474, September.
    4. Oliver Hart, 2003. "Incomplete Contracts and Public Ownership: Remarks, and an Application to Public-Private Partnerships," Economic Journal, Royal Economic Society, vol. 113(486), pages 69-76, March.
    5. Georg Inderst, 2009. "Pension Fund Investment in Infrastructure," OECD Working Papers on Insurance and Private Pensions 32, OECD Publishing.
    6. Fama, Eugene F, 1991. "Efficient Capital Markets: II," Journal of Finance, American Finance Association, vol. 46(5), pages 1575-1617, December.
    7. Vecchi, Veronica & Hellowell, Mark & Gatti, Stefano, 2013. "Does the private sector receive an excessive return from investments in health care infrastructure projects? Evidence from the UK," Health Policy, Elsevier, vol. 110(2), pages 243-270.
    8. 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.
    9. Fama, Eugene F, 1970. "Efficient Capital Markets: A Review of Theory and Empirical Work," Journal of Finance, American Finance Association, vol. 25(2), pages 383-417, May.
    10. 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.
    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. George Fragkiadakis & Michael Doumpos & Constantin Zopounidis & Christophe Germain, 2016. "Operational and economic efficiency analysis of public hospitals in Greece," Post-Print hal-01414677, HAL.
    2. George Fragkiadakis & Michael Doumpos & Constantin Zopounidis & Christophe Germain, 2016. "Operational and economic efficiency analysis of public hospitals in Greece," Annals of Operations Research, Springer, vol. 247(2), pages 787-806, December.
    3. Colla, Paolo & Hellowell, Mark & Vecchi, Veronica & Gatti, Stefano, 2015. "Determinants of the cost of capital for privately financed hospital projects in the UK," Health Policy, Elsevier, vol. 119(11), pages 1442-1449.

    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. Fay, Marianne & Martimort, David & Straub, Stéphane, 2021. "Funding and financing infrastructure: The joint-use of public and private finance," Journal of Development Economics, Elsevier, vol. 150(C).
    2. Daniel Albalate & Germà Bel & Richard R. Geddes, 2015. "“Strong versus Weak Vertical Integration: Contractual Choice and PPPs in the United States”," IREA Working Papers 201518, University of Barcelona, Research Institute of Applied Economics, revised Sep 2015.
    3. Schmitz, Patrick W., 2013. "Job design with conflicting tasks reconsidered," European Economic Review, Elsevier, vol. 57(C), pages 108-117.
    4. David Martimort & Stéphane Straub, 2016. "How To Design Infrastructure Contracts In A Warming World: A Critical Appraisal Of Public–Private Partnerships," International Economic Review, Department of Economics, University of Pennsylvania and Osaka University Institute of Social and Economic Research Association, vol. 57(1), pages 61-88, February.
    5. Schmitz, Patrick W., 2013. "Public procurement in times of crisis: The bundling decision reconsidered," Economics Letters, Elsevier, vol. 121(3), pages 533-536.
    6. David Martimort & Flavio Menezes & Myrna Wooders & LUCIANO GRECO, 2015. "Imperfect Bundling in Public–Private Partnerships," Journal of Public Economic Theory, Association for Public Economic Theory, vol. 17(1), pages 136-146, February.
    7. Elisabetta IOSSA & Stephane SAUSSIER, 2018. "Public Private Partnerships In Europe For Building And Managing Public Infrastructures: An Economic Perspective," Annals of Public and Cooperative Economics, Wiley Blackwell, vol. 89(1), pages 25-48, March.
    8. Daniel Danau & Annalisa Vinella, 2017. "From fixed to state‐dependent duration in public‐private partnerships," Journal of Economics & Management Strategy, Wiley Blackwell, vol. 26(3), pages 636-660, September.
    9. Elisabetta Iossa, 2015. "Contract and procurement design for PPPs in highways: the road ahead," Economia e Politica Industriale: Journal of Industrial and Business Economics, Springer;Associazione Amici di Economia e Politica Industriale, vol. 42(3), pages 245-276, September.
    10. Colla, Paolo & Hellowell, Mark & Vecchi, Veronica & Gatti, Stefano, 2015. "Determinants of the cost of capital for privately financed hospital projects in the UK," Health Policy, Elsevier, vol. 119(11), pages 1442-1449.
    11. Ram Singh, 2018. "Public–private partnerships vs. traditional contracts for highways," Indian Economic Review, Springer, vol. 53(1), pages 29-63, December.
    12. Li, Sanxi & Sun, Hailin & Yan, Jianye & Yu, Jun, 2015. "Bundling decisions in procurement auctions with sequential tasks," Journal of Public Economics, Elsevier, vol. 128(C), pages 96-106.
    13. Schmitz, Patrick W., 2015. "Government versus private ownership of public goods: The role of bargaining frictions," Journal of Public Economics, Elsevier, vol. 132(C), pages 23-31.
    14. Eva I. Hoppe & Patrick W. Schmitz, 2013. "Public-private partnerships versus traditional procurement: Innovation incentives and information gathering," RAND Journal of Economics, RAND Corporation, vol. 44(1), pages 56-74, March.
    15. Välilä, Timo, 2020. "An overview of economic theory and evidence of public-private partnerships in the procurement of (transport) infrastructure," Utilities Policy, Elsevier, vol. 62(C).
    16. Daniel Albalate & Germà Bel & R. Richard Geddes, 2017. "How Much Vertical Integration? Contractual Choice and Public–Private Partnerships in the United States," Review of Industrial Organization, Springer;The Industrial Organization Society, vol. 51(1), pages 25-42, August.
    17. Emily Poole & Carl Toohey & Peter Harris, 2014. "Public Infrastructure: A Framework for Decision-making," RBA Annual Conference Volume (Discontinued), in: Alexandra Heath & Matthew Read (ed.),Financial Flows and Infrastructure Financing, Reserve Bank of Australia.
    18. Christiane Goodfellow & Dirk Schiereck & Steffen Wippler, 2013. "Are behavioural finance equity funds a superior investment? A note on fund performance and market efficiency," Journal of Asset Management, Palgrave Macmillan, vol. 14(2), pages 111-119, April.
    19. Shi, Huai-Long & Zhou, Wei-Xing, 2022. "Factor volatility spillover and its implications on factor premia," Journal of International Financial Markets, Institutions and Money, Elsevier, vol. 80(C).
    20. David Martimort & Flavio Menezes & Myrna Wooders & ELISABETTA IOSSA & DAVID MARTIMORT, 2015. "The Simple Microeconomics of Public-Private Partnerships," Journal of Public Economic Theory, Association for Public Economic Theory, vol. 17(1), pages 4-48, February.

    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:hepoli:v:113:y:2013:i:1:p:77-85. 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 or the person in charge (email available below). General contact details of provider: http://www.elsevier.com/locate/healthpol .

    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.