PPP Analysis in Health Sector

Public-private partnership is a model in which the public and private sectors collaborate when the public lacks to provide adequate resources to serve people. The first PPP models began to come up in the field of electricity, drinking water, etc. in the 1990s, and after 2006, PPP has taken part in the health sector as Build-Lease-Transfer (Tekin, Çelik, 2012). Etlik City Hospital project, in accordance with the news article of Toker in Sözcü (2020, April 13th), can be demonstrated as one of the examples of PPP in the health sector. The project starting in 2012 was conducted by an Italian and a Turkish company. Under the information of the news, the expiry of the project has been postponed to 2021 which leads the cost of the project to increase.  

It can be demonstrated that there are three aspects that are interesting based on this case. The first one, and the main topic of the news article, is that hospital could not be completed on its planned time. According to the article of Tekin and Çelik (2012), one of the most important aims of PPP is to complete the project in a shorter time than the public does. For instance, while the public builds a hospital in 8-10 years, PPP builds it in 2-3 years. However, the Etlik City Hospital project, as being seen, has been lasting about 7 years since 2013 (it was stopped once). In this context, it has made it difficult or delayed for people to reach the public services contrary to the aim of PPP based on the characteristic of facilitating social benefit to the public and public sector (Tekin, Çelik, 2012). So, we can interpret that this project (not only this but also many of the hospital projects such as Bilkent C.H.) could not be gotten expected efficiency. In parallel to the first aspect, the second interesting thing is that the prolongation of the building process of Etlik C.H. has led the cost of the project to increase. According to the PPP understanding, the maximum quality and service should be provided at the minimum cost (Emek, 2017). However, the delay cost of the project raised more than 40 million euros in accordance with the news. We can interpret that this increase in the cost caused the project to cost much more than usual. Contrary to the aim, both private and public lost and spent much more money. Also, this, with a huge possibility, has led citizens to be obstructed to reach the public services in the field of health because many of the hospitals in Ankara was shut down for the sake of Etlik C.H. The third interesting part is the issue of the secret contracts. According to the news, this project has been conducted through a secret contract signed between actors as in the other projects. Unfortunately, this implementation can sometimes pave the way for corruption or graft, since “concepts like audit, transparency and common good might not be taken into consideration in the PPP model” (Tekin, Çelik, 2012). The secret contract also prevents the parliament to practice the power of supervision in this case and lies behind the questions emerging in people’s minds, such as how much the paid rent is. In such a situation, it is strongly possible to come out the moral issues. One of the issues is that I think, it has a little possibility of supervising the tender. What I mean is that it cannot be purely known if the company awarded the tender offered a bribe or whether the company did the cheapest offer or not. In the Etlik C.H case, it is claimed that the laborer was victimized for not being paid the debts. So, we cannot know where the money that should be paid to them is.

As we can see from Etlik C.H example, PPP implemented in the health sector, to me, is not efficient as it should be. Not only in this case but also in the other cases are great examples of unsuccessful implementation in terms of the fact that it leads the public to pay more rather than make a profit. I believe that the PPP model in the health sector causes the services to become commercialized and expensive.

REFERENCES

Şenel Tekin, P. & Çelik, Y. (2012). Türkiye’de sağlık sektöründe bir finansman yöntemi olarak kamu-özel ortaklığı politikasının politika haritalama yöntemi ile analiz edilmesi . Ankara Sağlık Bilimleri Dergisi , 1 (3) , 81-98 . DOI: 10.1501/Asbd_0000000031

Emek, U. (2017). Sağlık sektöründe kamu-özel işbirliği sözleşmeleri: beklenti ve gerçekleşme. Hacettepe Hukuk Fakültesi Dergisi, 7(1), 139-168.

Toker, Ç., (2020, April 13), Etlik Şehir Hastanesi 2021’e kalmış, Sözcü, https://www.sozcu.com.tr/2020/yazarlar/cigdem-toker/etlik-sehir-hastanesi-2021e-kalmis-5743704/