Email updates

Keep up to date with the latest news and content from BMC Health Services Research and BioMed Central.

Open Access Research article

Institutional public private partnerships for core health services: evidence from Italy

Giulia Cappellaro1* and Francesco Longo23

  • * Corresponding author: Giulia Cappellaro

  • † Equal contributors

Author Affiliations

1 Cambridge Judge Business School, University of Cambridge, Trumpington Street, Cambridge, CB2 1AG, UK

2 Centre for Research on Health and Social Care Management, Università Commerciale Luigi Bocconi, Via Roentgen 1, 20136 Milan, Italy

3 Department of Public Management and Institutional Analysis, Università Commerciale Luigi Bocconi, Via Roentgen 1, 20136 Milan, Italy

For all author emails, please log on.

BMC Health Services Research 2011, 11:82  doi:10.1186/1472-6963-11-82

Published: 19 April 2011



Public-private partnerships (PPPs) are potential instruments to enable private collaboration in the health sector. Despite theoretical debate, empirical analyses have thus far tended to focus on the contractual or project dimension, overlooking institutional PPPs, i.e., formal legal entities run by proper corporate-governance mechanisms and jointly owned by public and private parties for the provision of public-health goods. This work aims to fill this gap by carrying out a comparative analysis of the reasons for the adoption of institutional PPPs and the governance and managerial features necessary to establish them as appropriate arrangements for public-health services provisions.


A qualitative analysis is carried out on experiences of institutional PPPs within the Italian National Health Service (Sistema Sanitario Nazionale, SSN). The research question is addressed through a contextual and comparative embedded case study design, assuming the entire population of PPPs (4) currently in force in one Italian region as the unit of analysis: (i) a rehabilitation hospital, (ii), an orthopaedic-centre, (iii) a primary care and ambulatory services facility, and (iv) a health- and social-care facility. Internal validity is guaranteed by the triangulation of sources in the data collection phase, which included archival and interview data.


Four governance and managerial issues were found to be critical in determining the positive performance of the case examined: (i) a strategic market orientation to a specialised service area with sufficient potential demand, (ii) the allocation of public capital assets and the consistent financial involvement of the private partner, (iii) the adoption of private administrative procedures in a regulated setting while guaranteeing the respect of public administration principles, and (iv) clear regulation of the workforce to align the contracts with the organisational culture.


Findings suggests that institutional PPPs enable national health services to reap great benefits when introduced as a complement to the traditional public-service provisions for a defined set of services and goals.