A New Season for PPPs between Strategy and Sustainability Perspective: A Comparative Analysis in the Italian Healthcare Sector

The different varieties and intensities of crises over the past decade have led to a renewed vision of instruments for public intervention in collaboration with the private sector. The same COVID-19 crisis has strained infrastructure projects globally, and in particular public-private partnerships (PPPs), at all stages and in all sectors—with implications for governments, providers of infrastructure assets and services, their financiers, and end-users. Over the years, public-private partnership, with its various peculiarities, has become strategically important in areas where, previously, only public companies/public agencies operated. In particular, several management experiments aimed at introducing the use of special formulas of PPP in the management of public health authorities. The purpose of this study is to examine the strategic aims of PPPs and its viability in terms of sustainability.Case study methodology was chosen to achieve the objectives of the study. The Azienda USL Toscana and the ASL Pedemontana were identified as the two selected cases study. The main reasons for those choices are the subject of the survey, the operational differences between the Tuscany region and the Veneto region and the methods of data collection. The cases were developed through information collected by literature review; desk analysis of documentation provided by corporate managements and private partners and by conducting semi-structured interviews with actors involved in decision-making processes. Interviews were conducted with the Project Manager (the RUP of ASL Pedemontana and the Director of S.I.O.R Department of Azienda USL Toscana) of the public health authorities. In the private sector, both Chief operating officers were interviewed as project financing coordinators. A qualitative approach was used to analyze the interviews. In fact, through coding, respondents' views were highlighted. Finally, two evidences tree were constructed and the collected data were compared in order both to identify diffent practices and to archive a shared understanding of the phenomenon. The analysis of the project revealed very different management models. The current analysis has identified the main key problems of project financing: information asymmetry, the inadequacy of certain skills and difficulties in risk allocation. Through our analysis, we were also able to identify strategic choices for achieving better social, economic and financial outcomes. The evidences collected will make it possible to make more effective and efficient choices in the development of future projects between private actors and public institutions.