Public - Private Partnerships in Healthcare: A Literature Review
Abstract
As fiscal pressures intensify and healthcare needs continue to rise, public-private partnerships have evolved into a central policy response to close enduring gaps in infrastructure, financing, and service efficiency. This paper presents an integrative literature review of PPPs in healthcare sector, exploring their theoretical foundations and examining their conceptual underpinnings and the empirical results. Based on evidence from scholarly publications, institutional analyses, and international policy sources, the review highlights findings across diverse contexts from both advanced and developing economies.
Findings reveal that PPPs can markedly advance healthcare access, efficiency, and quality when backed by strong institutional capacities, clear governance mechanisms, and fair risk sharing. While case studies from Morocco, Iran, and Lesotho demonstrate the positive impact of PPPs on hospital functioning and patient care, other studies underscore persistent challenges such as budgetary exposure, governance deficits, and the growing financialisation of the healthcare sector.
According to the study, PPPs should not be viewed as a universal solution but rather as a governance approach whose success relies on robust state capacity, sound regulatory frameworks, and consistent policy alignment. When thoughtfully designed and efficiently implemented, PPPs can enhance the pursuit of equitable, efficient, and durable healthcare systems, notably within settings facing fiscal and infrastructural constraints.
Downloads
References
2. Basabih, N., Wahyuni, S., & Pujiyono, A. (2022). Public–Private Partnership in the health sector: A literature review of performance and challenges in hospitals. International Journal of Health Management, 15(2), 45–59.
3. Benhoummane, M., & Touab, O. (2022). Cadre conceptuel des partenariats public-privé. Revue Française d’Économie et de Gestion, 3(5), 491–501.
4. Birn, A. E., Pillay, Y., & Holtz, T. (2016). Textbook of International Health: Global Health in a Dynamic World (4th ed.). Oxford University Press.
5. Casady, C. B., & Mikic, M. (2022). Public–Private Partnerships and fiscal sustainability: Risk allocation, governance, and accountability. Public Money & Management, 42(5), 320–329. https://doi.org/10.1080/09540962.2021.1900552
6. Cordilha, A. C. (2022a). Public–Private Partnerships in healthcare: Between policy and finance. Global Health Governance Journal, 16(1), 45–67.
7. Cordilha, A. C. (2022b). The financialisation of healthcare systems: Actors, instruments, and implications. Social Science & Medicine, 301, 114908. https://doi.org/10.1016/j.socscimed.2022.114908
8. Dentico, N. (2019). Health partnerships and financialization: Private equity in the public interest? Development Journal, 62(1), 73–82. https://doi.org/10.1057/s41301-019-00206-4
9. Dentico, N. (2021). When finance captures health: The political economy of global health investment. Globalizations, 18(8), 1273–1289. https://doi.org/10.1080/14747731.2021.1877999
10. Doua, W., & Khariss, M. (2024). Les partenariats public-privé comme levier de développement des infrastructures au Maroc: Une revue de littérature. International Journal of Accounting, Finance, Auditing, Management and Economics (IJAFAME), 5(3), 320–335.
11. Gharaee, H., Khosravi, S., & Rahmani, R. (2021). Public–Private Partnerships in healthcare: A case study of East Azerbaijan Province, Iran. Iranian Journal of Public Health, 50(6), 1221–1233.
12. Ghasemi, M., Yousefi, M., & Rahmani, S. (2022). The effects of public–private cooperation on health service provision, coverage, and performance. BMC Health Services Research, 22(1), 445–459. https://doi.org/10.1186/s12913-022-07723-5
13. Hellowell, M. (2019). The case of Lesotho’s hospital PPP: A cautionary tale for health systems in Africa. BMJ Global Health, 4(e001217). https://doi.org/10.1136/bmjgh-2018-001217
14. Hodge, G., & Greve, C. (2017). On public–private partnership performance: A contemporary review. Public Works Management & Policy, 22(1), 55–78. https://doi.org/10.1177/1087724X16657830
15. Hunter, B. M., & Murray, S. F. (2019). Deconstructing the financialization of health in low- and middle-income countries. Social Science & Medicine, 217, 19–26. https://doi.org/10.1016/j.socscimed.2018.10.015
16. Joudyan, S., Rezapour, A., & Arab-Zozani, M. (2021). Public–Private Partnerships in the health sector: Opportunities and challenges. Journal of Health Management and Informatics, 8(4), 234–242.
17. Krivenko, A., Kuznetsov, A., & Didenko, V. (2021). Public–Private Partnerships and local health development: Evidence from Russia and international experiences. Journal of Health Economics and Management, 18(3), 205–221.
18. McIntosh, N., Grabowski, A., & Jack, W. (2015). Lesotho’s hospital PPP: A model for Sub-Saharan Africa or a cautionary tale? Health Policy and Planning, 30(6), 765–774. https://doi.org/10.1093/heapol/czu108
19. Montagu, D., & Harding, A. (2012). A road map for successful public–private partnerships for health care delivery. Health Affairs, 31(1), 75–83. https://doi.org/10.1377/hlthaff.2011.0936
20. Organisation for Economic Co-operation and Development (OECD). (2012). Public–Private Partnerships in healthcare: Policy guidance for governments. OECD Publishing. https://doi.org/10.1787/9789264177945-en
21. PricewaterhouseCoopers (PwC). (2018). Build and beyond: The (r)evolution of healthcare PPPs. PwC Health Industries Report.
22. Roehrich, J. K., Lewis, M. A., & George, G. (2014). Are public–private partnerships a healthy option? A systematic literature review. Social Science & Medicine, 113, 110–119. https://doi.org/10.1016/j.socscimed.2014.03.037
23. Romero, M. J., & Van Waeyenberge, E. (2020). Public–Private Partnerships in the health sector: Reframing the debate from development to financialisation. Development and Change, 51(2), 405–430. https://doi.org/10.1111/dech.12554
24. Sadeghi, A., Yusefi, A., & Bastani, P. (2022). Evaluating hospital PPPs: Comparative insights from the UK, Canada, Turkey, Australia, and Iran. International Journal of Health Planning and Management, 37(4), 1902–1917. https://doi.org/10.1002/hpm.3401
25. Stafford, A., Stapleton, P., & Shaoul, J. (2022). Public–Private Partnerships and the governance of healthcare: Risk, accountability, and the state. Public Administration Review, 82(1), 111–126. https://doi.org/10.1111/puar.13454
26. World Bank. (1993). World Development Report 1993: Investing in Health. Oxford University Press.
27. World Bank. (2017). Public–Private Partnerships Reference Guide (Version 3.0). Washington, DC: World Bank Group.
28. Yescombe, E. R. (2018). Public–Private Partnerships in Subnational Governments: Financing Infrastructure and Services. Elsevier Academic Press.
29. Zine El Abidine, M., Hajji, Z., & Bouhmala, A. (2023). The public–private partnership as a complementary mechanism for developing the health system and social protection: The case of dialysis services in Morocco. African Scientific Journal, 4(31), 57–72.
Copyright (c) 2026 Wissal Doua, Mohammed Khariss
This work is licensed under a Creative Commons Attribution 4.0 International License.
