Per far crescere i PPP facciamo prima crescere le competenze

"Le partnership pubblico-privato (PPP) sono contratti complessi e in passato sono senza dubbio stati commessi molti errori, che hanno sollevato dubbi sul loro rapporto qualità-prezzo e sulla loro convenienza", afferma Veronica Vecchi, docente di Public Management and Business Government Relations alla SDA Bocconi School of Management. Tuttavia, la non convenienza e il mancato valore dei PPP nel settore sanitario sono stati generati principalmente da un'errata pianificazione, dalla mancanza di competenze nel settore pubblico e dall'elevato moral hazard del mercato. Abbiamo bisogno di più PPP in tutto il mondo, per i loro vantaggi microeconomici (la maggiore efficienza dei progetti e la possibilità di finire i lavori in tempo, entro i limiti del budget e con la qualità richiesta), ma anche perché i PPP rappresentano un'interessante asset class per gli investitori. Tuttavia, per rendere i PPP una soluzione sostenibile, dobbiamo innovare il modello. Significa che abbiamo bisogno di meno cemento e di soluzioni più innovative, che possano aiutare le organizzazioni e i sistemi sanitari a diventare più efficienti, efficaci e inclusivi". Bocconi Knowledge, per gentile concessione di Palgrave Macmillan, pubblica un estratto dell'introduzione a Veronica Vecchi; Mark Hellowell (Eds): Public-Private Partnerships in Health, 2018, col permesso di Springer Nature. Il libro è disponibile qui


Increasingly, health sector policymakers deliver their objectives via public-private partnerships (PPPs) in which private companies are contracted to carry out a range of activities, including the delivery of physical assets- infrastructure and technologies-and related clinical and non-clinical services. Although large-scale and routinised use of PPPs originated in advanced economies such as Australia, Canada, France, Italy and the UK, it has recently expanded to many countries in which experience with public-private engagement is far more limited. In the latter case, PPPs- which enjoy influential support from multilateral development agencies and the World Bank in particular-often form part of broader efforts to enhance the role of the private sector in the implementation of health system's strengthening goals.

Due to the long-term character, financial complexity and risk-allocation mechanisms of the PPP model, it represents the most complex form of contracting transaction yet to have emerged in the health sector. As the model expands into new markets, and is also newly adopted by health agencies within countries where the model is already established, there is a recognition among scholars and practitioners alike that the competencies currently existing within the public sector are inadequate to the task of designing and implementing PPPs in which the general welfare of the population is safeguarded and advanced.

A considerable amount of effort has been exerted by international financial institutions and other supranational entities to address this capacity gap. The World Bank, most notably, has published numerous manuals, guidelines and literature reviews which address the high-level challenges faced by policymakers. Now, the challenge is to draw on and supplement that knowledge in defining the lessons for those at the front line-the managers of public authorities and the business that are at the front line of project delivery, and to make those lessons relevant to address the specific challenges in the health sector.

Based on over ten years of focused work on PPPs in the sector (as researchers, instructors and consultants), this book synthesises and distils the knowledge and experience accumulated by the two authors, Veronica Vecchi and Mark Hellowell, alongside that provided by others, with the aim of providing a clear guide to all actors (policymakers, managers and private companies) in the PPP domain. The goal is to produce a reference guide in which core principles, rooted in theory, evidence and practice, are articulated in a way that makes them operationally relevant to all PPP stakeholders.

Veronica Vecchi è Professor of Public Management and Business Government Relations presso SDA Bocconi School of Management.
Mark Hellowell è Senior Lecturer at the University of Edinburgh.