Project Finance In The Italian Healthcare System: Considerations On The State Of Art

In the last few decades, Project Finance (PF) has assumed particular relevance in the healthcare sector. PF is developed as a solution to the frequently observed lack of financial resources, technical-specific and managerial skills in public entities. With reference to the Healthcare sector, the Italian experience shows discontinuous recourse to PF in the last decade. The most intense growth period, in terms of on-going project numbers and relative value, was between 2003 and 2006. From 2007, there was an evident slowdown in the number of projects which, however, after this initial drop, did not hinder growth in total value of projects, which was more marked in 2011 and 2012. The actual convenience of these operation is not always clear. In many cases, it is the very asymmetry of skills between the parties involved, usually to the detriment of the public party, which leads to an unbalance in apportioning costs and benefits associated with implementation of the PF. This aspect, along with the financial difficulty of public actors, and therefore their difficulty in accessing different instruments of infrastructure financing, can significantly influence the contractual power of the parties. The high level of frequently seen public contributions in public works is therefore explained in this way. The aim of this paper is to analyze the Italian experience of PF in the healthcare system, trying to underline, from its application, the state of art and the pros and cons of this tool.Journal: European Journal of Accounting, Finance and Business