Lessons from the past: lights and shadows of public-private partnership in the Italian healthcare sector

This paper outlines characteristics of the diffusion of public-private partnership (PPP) and focuses attention on its use in Italy, especially in the healthcare sector. After more than a decade since its introduction, inspired by foreign experiences, the academic literature contribution to the debate and the empirical experiences have highlighted several gaps of the instrument with financial and managerial implications for the public sector. In particular, in Italy, with reference to the value for money, risks and accounting treatment, the initial uncertainty about appropriate measures for evaluating the projects, now, should lead to a more accurate reflection. Through a comparative analysis of two case studies - public hospitals -, the paper shows the most relevant areas in which it is a time for an urgent rethink of PPP utilization, as a lesson for the future.