(Hodge! &! Greve,! 2007).! !Without! a! regulatory! body! or! outside! verification! of!…

(Hodge! &! Greve,! 2007).! !Without! a! regulatory! body! or! outside! verification! of! costing! methodologies,!the!efficiency!argument!can!become!moot.!! Evaluating)PPP)–)what)is)success? The!challenge!surrounding!the!evaluation!of!PPPs!is!at!the!most!basic!level,!what! constitutes!success?!Is!a!PPP!successful!because!the!project!did not!require!refinancing?! It!is!successful!if!shareholders!received!a!targeted!internal!rate!of!return?!If!the!public!is! satisfied!with! the! services!delivered!or!if! the!project!is!on! time,!on!budget!and!within! scope,!does!that!result!in!a!successful!PPP?!How!does!one!gauge!which!factors!are!the! determinants!of!a!positive!outcome!and!which!stakeholders!take!priority!or!should!take! priority!in!these!partnerships? What!constitutes!success!is!varied!in!the!literature!and! from!the!perspective!of! various! stakeholders! but! there! are! some! over! arching! constructs! that! are! labelled! “success! factors”! of! PPPs.! Angerer! &! Hammerschmid! (2005)! state! that! these! factors! include!“clear!goals!and!responsibilities,!an!efficient!and!fair!sharing!of!risks,!incentives,! monitoring!and!political!support!within!an!enabling!regulatory!environment”.! When!evaluating! the!merit!or!success!of!a!PPP! the!most! rudimentary!decisions! must! be! considered.! This! includes! the! decision! for! the! public! sector! to! engage! in! partnerships! in! the! first! place,! the! level! of! risk! transferred! by! type! of! partnership! chosen,!and!the!objectives!that!were!set!for!the!partnership.!The!appropriateness!of!the! partnership! can! also! vary! across! sector! (Rosenau,! 1999).! ! Part! of! the! challenge! of! evaluating!the!success!of!these!relationships!is!that!there!is:! 47 “a!lack!of!independent!evaluators;!poor!evaluation! rigor;!poor!definition!of! the! “counterfactual”!against!which!the!PPP!is!judged;!evaluations!by!auditors!general!who,! in!most!jurisdictions,!cannot!question!government!policy;!the!use!of!inaccurate!discount! rates! for! time! valueFofFmoney! estimates! of! net! benefit;! inaccurate! estimates! of! risk! transfers!from!the!public!to!the!private!sector;!and!predicted!benefits!being!estimated! at!an!early!stage!of!a!longFterm!contract,!so! that!optimism!and!political!sensitivity!are! both! high.! As! well! as! the! debatable! value! for! money,! critics! have! also! charged! that! transaction!costs!have!been!high!and!competition!weak!despite!being!more!reliable!in! terms!of!onFtime!delivery!for!major!projects” (Hodge!&!Greve,!2007,!p.!9).! 48 Public6Private)Partnerships)in)Healthcare According! to! Blanken! and! Dewulf,! “governments! are! increasingly! looking! for! ways! to! cope! simultaneously! with! both! booming! health! care! costs! and! decreasing! governmental!budgets”!and!publicFprivate!partnership!arrangements!have!emerged!as! one! mechanism! to! manage! this! set! of! problems! (Blanken! &! Dewulf,! 2010).! ! The! literature!reveals!that!this!movement!away!from!traditional!public!sector!procurement! approaches! is! motivated! by! the! potential! to! transfer! risks! and! some! revenues! to! the! private! sector! in! order! to! create! efficiency! and! control! costs! in! the! health! sector.!! Blanken! and! Dewulf! argue! that! despite! the! emerging! trend! towards! use! of! PPP arrangements! in! the! health! sector! it! remains! unclear! to! what! degree! these! arrangements! are! able! to! respond! to! changing! demands! in! the! health! care! sector! (Blanken!&!Dewulf,!PPP!in!Health,!2010).!!The!unique!nature!of!the!health!system!means! that!there!are! few!proven!methodologies!by!which!to!accurately!measure!the!‘success! or!failure’!of!a!PPP!project!in!this!sector.!Further,!the!unique!nature!of!the!health!system! creates!an!increased!relevance!of!the!qualitative!elements!of!the!NIE!model.!Given!the! policyFsensitive! nature! for! healthcare,! stakeholder! perspectives! become! increasingly! powerful! and! qualitative! fmeasures! which! gauge! the! social! and! political! constraints! impacting!the!outcomes!of!PPP!projects.! Health)Care)in)Canada In! Canada!70%! of! health! care!is! publicly! funded! ranking! Canada!in! the! bottom! third! among! OECD! countries! in! terms! of! the! proportion! of! healthcare! that! is! funded

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