The current state and use of Public Private Partnerships for health infrastructure investment in France

Abstract

The purpose of this paper is to determine the current state and use of Public Private Partnerships (PPP) for hospital infrastructure investment in France. The first chapter aims at describing the situation in the United Kingdom with the Private Finance Initiative (PFI) and its evolution in the health sector. The resource to PPP is justified with the macro-economic objective of investing in health infrastructure while fixing the debt-to-GDP ratio. Its evaluation with the value for money (VFM) method has been very controversial. As the main inspiration for the PPP version in France for hospital investment, the first section about PFI will then be useful in the second section to understand how the PPP market works in France in this sector. The last section relates the way how PPP was promoted and then discredited. Particularly, it is shown that, although PPP was constructed on the basis of PFI, its popularity fell for different reasons. While PFI in the UK was mainly criticized because it turned out to be less profitable in terms of VFM than the Government claimed, France raised the debate about the way health has to be managed.