misunderstood! (Borchert,! 2004;! Sadran,! 2004;! Johnston! and! Gudergan,! 2007).! ! The!…

misunderstood! (Borchert,! 2004;! Sadran,! 2004;! Johnston! and! Gudergan,! 2007).! ! The! challenge!of!the!PPP!arrangement,!as!with!most!partnerships,!is!that!this!information!is! generally! not! included! in! the! contractual! obligations.! Therefore,! the! implicit! social! contract!is!wholly!dependent!upon!‘actor!behaviour’!of!the!various!stakeholder!groups! (Johnston!& Gundergan,!2007)!and!dispute!resolution!mechanisms. The!macro!perspective!of!political!rhetoric!has!many!facets!and!the!implications! of!context!can!vary!substantially!from!project!to!project.!!The!three!main!considerations! with! respect! to! PPPs! are! the! political! climate! in! which! the! project! is! evaluated,! the! climate!in!which!the!project!proceeds!and!the!climate!in!which!disputes!are!resolved.! Time! of! implementation! is! especially! important! for! the! health! care! sector,! as! policies!influencing!the!implementation!of!the!project!are!likely!to!change!(Blanken!A.!,! 2008).! ! Additionally,! time! of! implementation! can! have! an! effect! on! value! for! money! (VFM)! considerations! and! the! initial! perceptions! or! community! acceptance! of! the! project.!Because!of! the!intimate!link!between!government!and!private! sector!in! these! types!of!projects,!shifts!in!government!can!also!have!implications!on!existing!projects!in! progress.!Political!risks!can!also!be!more!difficult!to!mitigate!because!they!may include! aspects!of!political!symbolism.!The!PPP!may!become!a!representation!or!a!vehicle!of!a! political!agenda!or!policy!and!as!a!result,!must!succeed!or!fail,!at!any!cost!(Johnston!and! Gudergan,!2007).!! Rosenau! (1999)! argues! that! PPPs! have! the! potential! to! create! conflicting! interests!due!to!the!varied!pursuits!and!value!systems!of!the!two!sectors!involved!in!the! contract.!The!private!sector!is!predisposed!to!prioritizing!shareholder!return!and!taking! 39 measured!risks!where!as!the!public!sector!is!influenced!by!regulations!and!authorities,! political! opinion! and! the! achievement! of! societal! goals! (Rosenau,! 1999).! ! Additional! problems!arise!due!to!the!fact!that!public!taxpayers!may!not!welcome!the!idea!of!PPPs! due!to!a!perceived!lack!of!!transparency!in!the!private!sector.!!Full!disclosure!may!also! be! an! issue! for! the! private! sector! who! has! an! interest! in! protecting! proprietary! information!to!ensure!their!competitiveness!(Rosenau,!1999;!Flinders,!2005) Risk Risk!transfer!is!often!cited!as!one!of!the!major!benefits!of!the!PPP!model!and!can! refer!to!technicalFrational!risks,!social!risks!and!any!other!dimension!that!may!affect!the! outcome! of! the! partnership.! Risk! can! have! different! implications! to! each! of! the! stakeholders,! be! both! positive! and! negative! and! stakeholders! can! have! differing! perspectives! as! to! what! constitutes! a! risk! (Johnston! &! Gundergan,! 2007).! ! In! PPP! arrangements,!risks!are!inherent!in!the!project!so!the!emphasis!should!be!placed!on!the! optimal!allocation!of!risk!or!risk!transfer.!!This!can!“incentivize”!partners!to!ensure!that! objectives!of!the!agreement!are!met!(Reeves,!2005).!!Risk!transfer!has!the!opportunity! to! be! extremely! beneficial! to! the! public! sector! but! if! not! appropriately! managed! insufficient!risk!is!transferred!to!the!private!sector!(Flinders,!2005).!!There!is!very!limited! literature! with! respect! to! what! is! the! optimal! allocation! of! risk! in! hospital! PPP! arrangements!but!at!a!minimum,!the!success!of!the!transfer!of!risk!should!be!factored! into!the!analysis!of!these!arrangements. In! a! study! conducted! by! the! Canadian! Council! for! Public! Private! Partnerships! (CCPPP)!in!2003!regarding!hospital!PPP!projects,!the!authors!argued!that!the!valuation!

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misunderstood! (Borchert,! 2004;! Sadran,! 2004;! Johnston! and! Gudergan,! 2007).! ! The!…
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