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Spanish healthcare public private partnerships: The ‘Alzira model’

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  • Acerete, Basilio
  • Stafford, Anne
  • Stapleton, Pamela

Abstract

Global infrastructure reports suggest that, in the wake of the fiscal crisis, healthcare PPPs are seen as a growing area as governments switch attention to social welfare projects. Spain is unique in having had a PPP hospital in operation for over a decade which is funded through a capitation fee. This paper takes a critical approach to evaluate this project, with our analysis showing that the original project could never have been viable and that the renegotiation of the contract has been costly to the government. Viewing the contract through a financialised lens we can see how this contract has been used to ‘make up’ a market for the private delivery of public healthcare in Spain. We also call into question the role of the Spanish savings banks in financing this type of project, which has now been replicated with further hospitals in Spain and Portugal, as well as in developing countries such as Lesotho.

Suggested Citation

  • Acerete, Basilio & Stafford, Anne & Stapleton, Pamela, 2011. "Spanish healthcare public private partnerships: The ‘Alzira model’," CRITICAL PERSPECTIVES ON ACCOUNTING, Elsevier, vol. 22(6), pages 533-549.
    • Handle: RePEc:eee:crpeac:v:22:y:2011:i:6:p:533-549
    DOI: 10.1016/j.cpa.2011.06.004
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    References listed on IDEAS

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    1. Anne Stafford & Basilio Acerete & Pam Stapleton, 2010. "Making concessions: Political, commercial and regulatory tensions in accounting for European roads PPPs," Accounting and Business Research, Taylor & Francis Journals, vol. 40(5), pages 473-493.
    2. Benito, Bernardino & Montesinos, Vicente & Bastida, Francisco, 2008. "An example of creative accounting in public sector: The private financing of infrastructures in Spain," CRITICAL PERSPECTIVES ON ACCOUNTING, Elsevier, vol. 19(7), pages 963-986.
    3. Linda M. English, 2005. "Using public–private partnerships to achieve value for money in the delivery of healthcare in Australia," International Journal of Public Policy, Inderscience Enterprises Ltd, vol. 1(1/2), pages 91-121.
    4. Darrin Grimsey & Mervyn K. Lewis, 2004. "Public Private Partnerships," Books, Edward Elgar Publishing, number 2438.
    5. Pedro Barros & Xavier Martinez-Giralt, 2009. "Contractual design and PPPs for hospitals: lessons for the Portuguese model," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 10(4), pages 437-453, October.
    6. Darrin Grimsey & Mervyn K. Lewis, 2005. "Are Public Private Partnerships value for money?," Accounting Forum, Taylor & Francis Journals, vol. 29(4), pages 345-378, December.
    7. Jean Shaoul & Anne Stafford & Pam Stapleton, 2008. "The Cost of Using Private Finance to Build, Finance and Operate Hospitals," Public Money & Management, Taylor & Francis Journals, vol. 28(2), pages 101-108, April.
    8. Guillem Lopez‐Casasnovas & Joan Costa‐Font & Ivan Planas, 2005. "Diversity and regional inequalities in the Spanish ‘system of health care services’," Health Economics, John Wiley & Sons, Ltd., vol. 14(S1), pages 221-235, September.
    9. Monrad Aas, I. H., 1995. "Incentives and financing methods," Health Policy, Elsevier, vol. 34(3), pages 205-220, December.
    10. Thompson, Ceri R. & McKee, Martin, 2004. "Financing and planning of public and private not-for-profit hospitals in the European Union," Health Policy, Elsevier, vol. 67(3), pages 281-291, March.
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