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Does the private sector receive an excessive return from investments in health care infrastructure projects? Evidence from the UK

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  • Vecchi, Veronica
  • Hellowell, Mark
  • Gatti, Stefano

Abstract

This paper is concerned with the cost-efficiency of Private Finance Initiatives (PFIs) in the delivery of hospital facilities in the UK. We outline a methodology for identifying the “fair” return on equity, based on the Weighted Average Cost of Capital (WACC) of each investor. We apply this method to assess the expected returns on a sample of 77 contracts signed between 1997 and 2011 by health care provider organisations in the UK. We show that expected returns are in general in excess of the WACC benchmarks. The findings highlight significant problems in current procurement practices and the methodologies by which bids are assessed. To minimise the financial impact of hospital investments on health care systems, a regulatory regime must ensure that expected returns are set at the “fair” rate.

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  • Vecchi, Veronica & Hellowell, Mark & Gatti, Stefano, 2013. "Does the private sector receive an excessive return from investments in health care infrastructure projects? Evidence from the UK," Health Policy, Elsevier, vol. 110(2), pages 243-270.
    • Handle: RePEc:eee:hepoli:v:110:y:2013:i:2:p:243-270
    DOI: 10.1016/j.healthpol.2012.12.010
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    Cited by:

    1. Kate Bayliss, 2016. "The Financialisation of Health in England and Wales; Lessons from the Water Sector," Working papers wpaper131, Financialisation, Economy, Society & Sustainable Development (FESSUD) Project.
    2. Inderst, Georg, 2020. "Social Infrastructure Finance and Institutional Investors. A Global Perspective," MPRA Paper 99239, University Library of Munich, Germany.
    3. Nannan Wang & Minxun Ma, 2021. "Public–private partnership as a tool for sustainable development – What literatures say?," Sustainable Development, John Wiley & Sons, Ltd., vol. 29(1), pages 243-258, January.
    4. repec:ces:ifodic:v:12:y:2014:i:3:p:19126467 is not listed on IDEAS
    5. Aidan Vining & Anthony Boardman, 2014. "Self-interest Springs Eternal: Political Economy Reasons why Public-Private Partnerships Do Not Work as Well as Expected," ifo DICE Report, ifo Institute - Leibniz Institute for Economic Research at the University of Munich, vol. 12(3), pages 17-23, October.
    6. Inderst, Georg, 2017. "UK Infrastructure Investment and Finance from a European and Global Perspective," MPRA Paper 79621, University Library of Munich, Germany.
    7. Ivanov, A., 2015. "On the new approach to the risks' identification in the projects of public-private partnership," Working Papers 6414, Graduate School of Management, St. Petersburg State University.
    8. Aidan Vining & Anthony Boardman, 2014. "Self-interest Springs Eternal: Political Economy Reasons why Public-Private Partnerships Do Not Work as Well as Expected," ifo DICE Report, ifo Institute - Leibniz Institute for Economic Research at the University of Munich, vol. 12(03), pages 17-23, October.
    9. Emily Poole & Carl Toohey & Peter Harris, 2014. "Public Infrastructure: A Framework for Decision-making," RBA Annual Conference Volume (Discontinued), in: Alexandra Heath & Matthew Read (ed.),Financial Flows and Infrastructure Financing, Reserve Bank of Australia.
    10. Dejan Makovšek & Marian Moszoro, 2018. "Risk pricing inefficiency in public–private partnerships," Transport Reviews, Taylor & Francis Journals, vol. 38(3), pages 298-321, May.
    11. Colla, Paolo & Hellowell, Mark & Vecchi, Veronica & Gatti, Stefano, 2015. "Determinants of the cost of capital for privately financed hospital projects in the UK," Health Policy, Elsevier, vol. 119(11), pages 1442-1449.
    12. Jing Du & Hongyue Wu & Xianbo Zhao, 2018. "Critical Factors on the Capital Structure of Public–Private Partnership Projects: A Sustainability Perspective," Sustainability, MDPI, vol. 10(6), pages 1-27, June.
    13. Hellowell, Mark, 2013. "PFI redux? Assessing a new model for financing hospitals," Health Policy, Elsevier, vol. 113(1), pages 77-85.
    14. Martijn van den Hurk & Marlies Hueskes, 2017. "Beyond the financial logic: Realizing valuable outcomes in public–private partnerships in Flanders and Ontario," Environment and Planning C, , vol. 35(5), pages 784-808, August.
    15. Burke, Richard & Demirag, Istemi, 2015. "Changing perceptions on PPP games: Demand risk in Irish roads," CRITICAL PERSPECTIVES ON ACCOUNTING, Elsevier, vol. 27(C), pages 189-208.
    16. Mark A. Moore & Aidan R. Vining, 2023. "PPP performance evaluation: the social welfare goal, principal–agent theory and political economy," Policy Sciences, Springer;Society of Policy Sciences, vol. 56(2), pages 267-299, June.
    17. Inderst, Georg, 2015. "Social infrastructure investment: private finance and institutional investors," MPRA Paper 69504, University Library of Munich, Germany.

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