and functional adaptations seem hardly compatible with the funding rules of PPP contracts; – Big…

and functional adaptations seem hardly compatible with the funding rules of PPP contracts; – Big companies and their subsidiaries have won most of the PPP contracts against small and medium enterprises; – In some cases, relationship between the public and the private partners deteriorated and projects faced delays due to disputes between the parties (case of Eiffage group for the Sud-Francilien Hospital Centre project); – Critics point out the lack of transparency for contract negotiations or renegotiations. In additions it is believed that in the PPP framework public healthcare is reduced into pure management accounting; – Foreign ownership in relation to public services in France is a very sensitive issue. In this context non-French companies are likely face discrimination to participate in the local PPP markets. There though room for encouraging foreign company participation in issues such as information systems, electronic medical records, energy production and logistics. 14.References ANAP (previously MNAIH) – Guide BEH, Février 2005 ; – Première contribution sur la relation investissement exploitation dans les constructions hospitalières publiques, avril 2006 ; – Le Partenariat Public-Privé Hospitalier, une premiere evaluation, Sep 2007 ; – La réalisation du plan d’investimenet national ‘Hopital 2007’ Synthèse, Aout 2009 ; – Convention constitutive (http://www.anap.fr/fileadmin/user_upload/01- ANAP/historique/ConventionConstitutiveANAP.pdf); – Rapport d’activité 2011 ; – Rédiger un marché de conception-réalisation Démarches et pratiques organisationnelles, 2012. EPEC – State guarantees in PPPs A guide to better evaluation, design and management, May 2011 ; – Le guide EPEC des PPP Manuel de bonnes pratiques, Avril 2012; – France PPP Units and Related Institutional Framework, May 2012. Cours des comptes – L’organisation de l’hôpital (unknown date) ; – Rapport d’observations définitives centre hospitalier Sud-Francilien, Sept 2010. Linklaters – Lignières et al., PPP in France – Healthcare Sector, Sept 2004 ; – Latledge et al., PPP in France – 2006, June 2006. Health and Economics Analysis for an Evaluation of the Public Private Partnerships in Health Care Delivery across EU 117 Project Case Study CH Henri Laborit Hospital 1. Background information CH Henri Laborit, a specialized hospital for mental health employs about 1250 workers and ensuring follow-up of almost 18 000 patients. It has 303 beds for inpatient psychiatric care, 61 places for day care. The site covered is 41ha and has 13 buildings, including 7 of hospitalization, 3 buildings for ambulatory care and 3 buildings for administration. With greenhouse gas emissions of about 8795 tonnes equivalent in CO2, in 2011, the hospital greenhouse gas emissions is higher than what a town of 880 inhabitants produces. French Public Health Code6 makes it possible for design, construction, maintenance and operation aspects to be conducted by private providers allowing deferred payment mechanisms for benefiting insitutions. Under the health sector ANAP (Agence Nationale d’Appui à la Performance des établissements de santé et médico-sociaux) is responsible for technical supervision and support to the ARHs7 and public healthcare institutions from inception of individual schemes onwards. It is as well responsible for the development of legal and financial framework in liaison with MAPPP (Mission d’appui aux partenariats public-privé under the Ministry of economy) which is the national PPP authority. Prior to the introduction of energy performance PPP contract the hospital was facing a gradual depletion of fossil fuels at the national and global level (thus higher energy costs) which triggered the ideas to move to biomass energy and enhancement homegrown wood energy. Besides, to meet its rising energy consumption needs the hospital would require investments up to 7MW installed capacity of which operating costs were increasingly high. The only realistic solution was to mitigate investment by using a heating network and biomass boiler. Thanks to this mechanism it was possible via the French Environment and Energy Management Agency (ADEME) to have access to regional grants regional and significant subsidies via the ‘Fonds chaleur’ available to all initiatives with significant reduction in greenhouse emissions. 2. Type of PPP, arrangement and service commitments Type of contract This a partnership contract on energy performance (European Directive 2006/32/EC) by which COFELY (GDF-Suez Consortium) committed to design, set up, finance, maintain and operate a heating network supplied by a wood boiler and, as accessory, to provide most of the hospital wards with solar thermal for the production of hot water, and to perform insulation work in buildings for more energy efficiency. 6 Law n° 2003-850 of September 2003 on simplification of the structure and the functioning of health system in France, Law n° 2004-559 of June 2004 on partnership contracts, Law n° 2004-806 on public health policy (Bail Emphytéotique Hospitalier – BEH, Bail Emphytéotique Administrative – BEA and Code of Social action and families – CASF) 7 At the Regional level, PPPs are under the responsibility of regional hospitalization agency (ARH -Agence Régionale d’hospitalisation) incorporated in the regional public health authority (agence régionale de la santé – ARS).

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