The development of public-private partnerships (PPPs) in the provision of health care services is a central feature of public policy in many countries. The authors argue that the nature of these partnerships is largely determined by the attitudes and understanding of the public managers responsible for managing relationships with private partners. In a study from the United Kingdom, these attitudes are examined through a qualitative analysis of interviews with 30 public managers and seven managers from one private partner. Findings are that public managers use private providers in a pragmatic fashion to satisfy shortterm requirements, with low priority assigned to the long-term strategic goals and benefits spoken of by politicians that support PPPs. Background: The development of public-private partnerships (PPPs) in the provision of public services, and of health care services in particular, is a central feature of public policy throughout the developed world. Nevertheless, government intentions for the role of the private sector in health care provision remain unclear. Governments use the concept of partnerships in two distinct, broad categories: economic partnership, in which assets are jointly committed and risk is shared; and organizational partnership, a general term to describe cross-organizational collaboration, alliances, and networking. Regardless of government intentions, the nature of PPPs will largely be determined by the attitudes of local public sector managers to the private sector, and their understanding of the partnership concept. This UK study interviews local managers to investigate these attitudes and their implications for future health care policy.

Methods: The study reports the findings of the first phase of ongoing qualitative research exploring the nature of PPPs in the health care arena. The focus is on one private company, Westminster Health Care, which is involved in PPPs with the government in four separate facilities involved in providing a range of services including long-term care and mental health. Interviews were conducted with 30 public-sector managers responsible for planning and purchasing services from Westminster facilities, and with seven Westminster personnel. Results from these interviews were analyzed qualitatively, identifying key themes.

Findings: There was limited evidence of true economic partnerships between the public and private sector. The majority of contracts or agreements in place with each of the four study sites were the product of spot purchasing of specific services over the short-term, with little in the way of long-term commitments to risk sharing. Public managers entered into contracts as pragmatic solutions to shortterm capacity requirements, with low priority assigned to the need to develop long-term strategic partnerships with the private sector. Public managers' consistent desire for flexibility in obtaining required capacity explains the prevalence of short-term contracts with private operators. While purchasers were pleased with the flexibility provided by private partners, there appeared to be a limited understanding of the relationship between flexibility and cost. Private managers, on the other hand, understood this relationship well, preferring long-term contracts, but recognizing that prices were adjusted to compensate for greater flexibility. While public managers were generally satisfied with their relationships with the private partner, there was a perception that private investment in health care was compromising the ability to publicly plan resource allocation. Private entrepreneurs invest in high valueadded services that are paid for with public funds that might otherwise support more basic publiclyprovided services.

Conclusions: The PPPs examined in this study demonstrate the characteristics of neither economic nor organizational partnerships. Public managers approach PPPs in a largely pragmatic fashion in order to best satisfy short-term requirements. Long-term strategic goals that might be realized through greater integration, cooperation, and risk sharing are generally assigned low priority. In such an environment, the hoped-for cost and efficiency gains from increased use of private providers of health care services may not materialize.

Reference: Field J.E. and Peck E. "Public-private partnerships in healthcare: the managers' perspective". Health and Social Care in the Community, November, 2003; 11 (6), 494-501.