Implementation of public-private partnerships in the health care sector: the case of Albania

The Public-Private Partnership (PPP) phenomenon is enjoying a global revival of popularity, despite much uncertainty on the definitions of partnership and the colorful experience gained from their practical application. While they are being rapidly embraced not only in free market and developed economies but also in developing countries, uncertainties persist as to what exactly is innovative – or fruitful - about PPP. In developed countries, the evolution of PPP to "state after welfare", reflects a shared experience in systems theory that has evolved substantially, particularly in Western Europe economies. Thus, on the one hand, PPP are increasingly being a way to renew the production and management of public services. On the other hand, their performance continues to be subject of debates. Although public-private partnerships (PPP) are often analyzed in terms of efficiency, their impact on the public and effectiveness are often overlooked. Henceforth, it has generated little empirical evidence that supports or disputes the claim of how PPP can contribute to the creation of public values. When it comes to their implementation there are different cases of success as well as failure in developed and developing countries. Although there is extensive literature in OECD countries, evidence on implementation of PPP in other contexts is lacking. The research focuses on the implementation of the PPP in the healthcare sector starting from the international experience in this field studing the case of introduction of the phenomena in Albania, where PPP are increasingly used as another scheme of private sector intervention. Public Private Partnerships (PPP) constitute a partnership with many different applications in the social sphere, in healthcare as well. Some European countries were pioneers in establishing these new forms of cooperation. Albania was one of the countries that followed suit. The aim of this paper is to discuss the case of the implementation of public-private partnerships in the Albanian heath care sector, as well as the impact of this entrepreneurial activity. The primary focus of this paper is to provide a complete and updated picture of the international implementation of PPP considering Albania as a case study in the Healthcare sector aim to evaluate PPP as an alternative means of production of public works and services especially in this field. To this purpose, a systematic review of the international letterature that have studied the implementation of PPP in the healthcare sector is carried out, in order to assess how the implementation of the PPP has evolved over time, reviewing the results achieved in order to 4 give a point of view in considering the use and the implementation of PPP in the Healthcare sector with the advantages, disadvantages, the success as well as the failure cases. In the second chapter, an analysis of the implementation of PPP in the healthcare sector in Albania was conducted aim to give an answer to the research question regarding the characteristics and the main results of the implementation of PPP in the healthcare sector starting from 2013, year of the entrance in force of the law on PPP. A study of the legal elements of the process aim to identify the factors and legislative elements that have obstructed or promoted the effectiveness of PPP in the healthcare sector. At the end the purpose of the research with come to a conclusion regarding the mean advantages or disadvantages of the implementation of PPP in the health sector. In the third chapter, this study attempts to provide an overview of, three out of four in total, actual cases of implementation of PPP in the healthcare from the Ministry of Health of Albania. In making an effort in filling the gap of information regarding the implementation of PPP in the healthcare sector in Albania the study aims at overviewing the legalislation and institutional background as well as the implementation of these contracts in the healthcare. Finally, the evaluation of the implementation of PPP along with suggestions for future action aimed at profit maximization, better utilization of the projects and maximization of social benefits are made, taking under consideration the ever-increasing demands and special socioeconomic circumstances specially under this Global Pandemic moment. The research offers as well several contributions to the on-going debate on PPP in different sectors focusing to the health sector aim to improve the quality and effectiveness of healthcare services. By directly addressing and discussing, from an interesting angle of analysis (the Albanin healthcare system), the application of good governance principles when implementing a PPP, this research fills the specific knowledge gap and lack of findings on the use of PPP in the healthcare sector. Finally, the main findings from these case studies offer interesting insights for practitioners by evidently emphasizing which are the key factors of successful implementation of a PPP in healthcare. The main evidence of three case-studies and final reccomandation on future research directions are subsequently provided.