Project and contract management in hospital Public-Private Partnerships:
A strategic analysis of the Portuguese experience
Abstract
Portugal has a vast and intricate public health system that is being
impacted by rising costs. The concepts of New Public Management,
together with foreign experience, drove the creation of public-private
partnership (PPP) models around the turn of the century to enhance the
focus on performance and cost-effectiveness in healthcare. The first
wave of PPPs, which began in 2001, featured an innovative and integrated
concept that linked hospital infrastructure building and administration
with clinical service delivery. The growth of PPP projects to avoid
financial limitations reveals a lack of strategic thinking and the
government’s short-term perspective on contracts lasting up to 30 years.
Various procedural delays, miscalculated costs, and external advice on
contract monitoring have exposed the public sector’s incapacity to
handle complex projects and contracts properly. Following a widely
criticized first wave that resulted in some clinical service delivery
going back to the public sector, Portugal is now seeking to establish a
second wave of hospital PPPs that do not include this problematic
component. In response, this work suggests Portugal’s first strategic
management method for managing healthcare PPPs. This paper initially
examines the Portuguese legal framework before doing an organic SWOT
analysis that combines the expertise of national PPP specialists.
Filling existing knowledge gaps in public institutions, increasing tight
collaboration and accountability with the private sector, and examining
methods to contract management, renegotiation, and value-for-money
evaluations are all recommended in the strategic formulation.