Origins and Developments of Public-Private Partnerships in the Health Care Systems in Developed Countries : Principles, Stakes, and Institutional Challenges

The public-private partnership (PPP) is a trendy model in public administration. It is moved by a dynamic in which the modern welfare State steps back in favor of a strategist State whose objectives of general interest are met relying on both public and private economic sectors. In an era that sees governments of many countries facing disheartening political and social economic choices and where the States seem to be experiencing an increase in health expenses, many think that the PPP model offers new resources that will affect health systems by increasing their managerial efficiency and improving the services they offer to citizens. This article aims at giving rise to a set of questions linked to the PPPs in health care systems. The historical context that contributed to their emergence is first presented. Constraints, stakes, and challenges are then identified as idiosyncratic to such a sensitive sector as health. It is therefore suggested that, because the real stakes for public services are rather managerial and organisational, the PPP constitutes an alternative that should be complementary rather than a replacement to the State's contribution. In fact, today's challenge for the State is to make an optimal use of both the possibilities offered by an efficient private management and the means that surge from good public governing. Conditions would therefore be fulfilled to fashion a health system that will combine organisational optimisation and users' satisfaction