Build and Beyond: The Revolution of Healthcare Public-Private Partnerships, a 2010 report from Pricewaterhouse Coopers, tracks the evolution of the PPP models and explores how the capital and operational structure provided by PPPs can be leveraged more broadly to address governmental demands for greater efficiency in health spending.


Government spending on healthcare is growing at a pace that is likely to be unsustainable unless new funding sources are found.


With the global recession, governments are increasingly looking to PPPs to solve larger problems in care delivery and wellness that are driving spending.


The larger scope of PPPs means a much larger potential market for private organizations. Infrastructure represents only five percent of health spending. However, health spending beyond infrastructure—95 percent—will total more than $88.1 trillion. This huge spend will become a target for government efficiency and create a market for private investment and management.


The measurements of success in PPPs are evolving toward health outcomes and performance. Healthcare infrastructure PPPs are more focused on better procurement and value for money.


In service delivery, PPP arrangements open broader conversations about how to create and maintain locally-based sustainable health systems. Governments typically agree to build in profit margins to induce private sector involvement. Competition and later reductions in government payments are then used to generate long-term savings and improve quality.


PPPs are increasingly developed by local, rather than national governments, that are closer to local health needs. However, national governments are important to setting a policy framework that enables local regulations.


Technology was often left out of PPP infrastructure deals, but is central to the new generation of PPPs in which manufacturers are often risk partners themselves, as service delivery becomes more integral to PPPs.


PPPs are challenging the notion that private healthcare is for the rich, and public healthcare is for the poor. Rather than creating or exacerbating inequities in care, PPPs can equalize care across all populations.