PPP’s Application in Greek Health Infrastructure and Personnel’s Response

PPP’s Application in Greek Health Infrastructure and Personnel’s Response

Georgios N. Chatzipoulidis (Department of Civil Engineering, Aristotle University of Thessaloniki, Thessaloniki, Greece), Georgios N. Aretoulis (Department of Civil Engineering, Aristotle University of Thessaloniki,Thessaloniki, Greece) and Glykeria P. Kalfakakou (Department of Civil Engineering, Aristotle University of Thessaloniki, Thessaloniki, Greece)
Copyright: © 2011 |Pages: 15
DOI: 10.4018/jhdri.2011100101
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Abstract

Financial crisis is particularly acute in Greece. Public Private Partnerships (PPPs), under these conditions, appear as a “reasonable” strategic decision. A PPP’s project implementation requires a high level of preparation, especially in the sensitive area of the National Health System (NHS). The implementation of PPPs projects in Health Sector, has recently initiated in Greece, while the relevant legal framework has been already voted since 2005. Many people express reservations about the extent and the content of this implementation. The aim of the current survey was to measure the satisfaction of health professionals in the public sector from the existing infrastructures and the assessment of their attitude to the prospect of PPP’s application to upgrade health infrastructure and health services. Results focus on the response of the hospital executive personnel towards PPP’s implementation. The research found a generally positive response to PPPs, while at the same time this approach is being characterized as a last resort. The positive reaction was identified in the involvement of the private sector, in providing support services during the contract, according to the current legislative framework. On the other hand, there is a significant opposition towards any prospect of transferring to the private investor, services related to medical and nursing care.
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1. Introduction

The Public - Private Partnerships (PPPs) are contractual relationships of long-term contracts between a Public and a Private Entity for projects and / or services. According to the final contract, the private contractor is required to finance the investment, and assumes significant responsibility for project design. Contracting Authority shall determine its requirements, based on operational specifications, and approve the detailed design stage (Weiler, 2006).

The Private contractor receives its payment, during the operation phase of the project, either directly from the users or by charging, in annual basis, the Contracting Authority or, in some cases by both. An agreement on allocating risk between the parties should be made (Froud & Shaoul, 2001; Weiler, 2006).

In recent years, PPP agreements have been contracted in many areas of public interest all over the world, but also at the European Union and particularly in United Kingdom. The increase in the number of PPPs originates from the budgetary constraints, faced by governments. At the same time, they offer to the public sector the ability to benefit from Private sector’s expertise and working methods (Chou, Tserng, Lin, & Yeh, 2012; Tang, Shen, & Cheng, 2010).

Projects, built with PPPs, could be divided into non-contributory and contributory.
A contributory PPP is usually a concession project. In this project, private Sector is responsible for exploitation, as well as for financing, design, construction and maintenance of the project. Infrastructure is usually transferred to the Public Sector in the end of conventional work session (Dimoglou, 2002; Technical Chamber of Greece, 2009). Typical contributory projects are transportation, environmental and energy projects.

A PPP project or service is defined as a non-contributory when there is no element of exploitation from private parties. It is basically a social infrastructure or service, which is operated by the state and enjoyed freely by citizens. In these projects, such as schools or hospitals, Private Sector is responsible for the implementation, redeemed directly from the state, and assumes risks associated with financing and construction, but not the risk of demand. Instead of this, Private Sector takes the risk of availability, in other words, the management and maintenance of infrastructure or service to make it operational. They have to maintain this functionality in a clearly preset context and quality level, for a period set by the partnership contract. After the contract operating period, infrastructure is transferred to the State (André & Hermann, 2008; Froud & Shaoul, 2001; Technical Chamber of Greece, 2009; Wall & Connolly, 2009).

Under such a partnership, commercial or other uses can emerge, by the exploitation of a part of the infrastructure or service (e.g. exploitation of commercial space in a building which housed a hospital). In each case, the size of these investments is small compared to the whole project.

Despite the potential advantages that collaboration between the public and private sectors can provide, PPPs should not be considered neither as a panacea to solve financial problems in the public sector, neither as the only means for the expansion of public infrastructure or public services (HM Treasury, 2004; Ng, Wong & Wong, 2012).

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