1 / 16

CASE STUDY: PPP in Italian Health Sector Massimo Ricchi Presidency of the Council of Ministers Department for Economic

CASE STUDY: PPP in Italian Health Sector Massimo Ricchi Presidency of the Council of Ministers Department for Economic Policy Coordination and Planning PPP Task Force, Italy . Geneva, 21-24 February 2012. The Task-Force – Organization.

razi
Download Presentation

CASE STUDY: PPP in Italian Health Sector Massimo Ricchi Presidency of the Council of Ministers Department for Economic

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. CASE STUDY: PPP in Italian Health Sector Massimo Ricchi Presidency of the Council of Ministers Department for Economic Policy Coordination and Planning PPP Task Force, Italy Geneva, 21-24 February 2012

  2. The Task-Force – Organization UTFP activity “on the field” : institutional framework Inspired by the UK PFI Taskforce Established by law Previous consultation with the main parties involved Group of 11 professionals: Legal, financial, technical expertise selected from both private and public sector.

  3. The Task-Force - Mission UTFP activity “on the field” : institutional framework (2) Educational Role • Promoting PPP techniques • Developing a PPP Methodology • Identifying workable PPP projects to be repeated • Database of successful PPP deals Assistance Role • Assistance to central, regional and local administrations • From the identification of suitable projects to the evaluation of offers • Multidisciplinary skills and expertise “Policy Making” Role • Improvement of legal framework • “Best practices” (standardisation of practices and contracts) Check PPP Contract for National Bureau of Statistic • Analysing risk distribution in the contract in order to put public investment on or off the public budget

  4. Project Finance in the Health sector in Italy since 2004 Some figures: • ca. 5,15 billion euro total investment • ca. 17.300 beds • 240.000 – 300.000 € average cost of bed Initiatives: • 15 initiatives currently planned (0,8 billion €) • 53 concession awarded (3,7 billion €) • 15 initiatives at bidding stage (0,65 billion €) • 61 initiatives quitted (1.950 billion €) Public contribution in capital expenditure (grant amount): • Average grant amount: 55% of Capex Average procedure duration to conclusion: • Public initiative procedure: 13,4 months • Private initiative procedure: 36,8 months

  5. Project Finance in the Health sector in Italy since 2004(2)

  6. Project Finance in the Health sector in Italy since 2004 (3) North 47 Centre 7 South 20 PPPs in the Italian Heath Sector 2004-2011 2 21 2 • >10 projects 9 1 5 4 3 • 5-10 projects 4 1 • 3-5 projects 1 2 5 • 1-2 projects 3 1 3 3 5

  7. Project Finance in the Health sector: fundamental principle What the private sector can do: Providing non- medical services • Estate maintenance • Supply of energy and fluids (heat, air conditioning, water, medical fluids, etc.) • Medical equipment maintenance • Cleaning services of building and clinical equipment • Laundry • Waste disposal • Catering for patients and personnel • Security services • Housing services (Reception, booking, management of hotel facilities, etc.) • IT services • Commercial services (bar, newspaper, restaurant, shops, etc.) • Parking facilities • Laboratories and Radiodiagnostic service management (occasionally) What the private sector cannot do: Providing medical services • No nursing and clinical services delivery • No medical ruling of the hospital PPPs in the Italian Health Sector

  8. Project Finance in the Health sector: strong contracting authority Lombardy's procurement approach • 6 hospitals in Lombardy • 4 hospitals in Calabria

  9. Project Finance in the Health sector: catch the innovation The Innovative procurement approach • THE FOUR TUSCANY HOSPITALS • THE NEW MESTRE HOSPITAL • THE CANCER THERAPHY CENTER MESTRE

  10. Project Characteristics The new Mestre Hospital The project concerns the construction of a new hospital to replace an inadequate existing hospital to consolidate and improve specialist hospital services (e.g. oncology, cardiology, eye-surgery). PROJECT DATA • Project Name: The new Mestre Hospital • Category: DBFO (Design Build Finance & Operate) • Awarding Authority: Unità Sanitaria Locale 12 Venice (NHS Local Authority) • Procedure: Concession under private initiative • Number of beds: 680 • Number of Op. Rooms: 16 • Number of Intensive Care Rooms : 24 • Parking Spaces : 1092 ( incl. 557 for visitors) • Total investment : € 245 million (VAT included) • Public contribution: € 105 million (45%) • Concession length: 29 years (incl. 4 years of construction)

  11. Mestre Hospital: a case of success January 2008 Official Opening of the new Mestre Hospital

  12. What to improve • No specific risk assessment or risk analysis realized in the early stage of the project through a matrix of risks • Case studies prepared by the promoter • Difficulties in comparing proposal in the different stage of the procurement process • Need to revise some financial aspects of the concession

  13. THE CANCER THERAPY CENTER:Project Characteristics The Cancer therapy Center The project concerns the construction of a Cancer therapy center. The new center will be part of an existing hospital to consolidate and improve specialist hospital services. The project was awarded and the contract signed. PROJECT DATA • Project Name: Cancer therapy centre • Category: DBFO (Design Build Finance & Operate) • Awarding Authority: (NHS Local Authority) • Procedure: Concession under private initiative • Bidders: 3 • Project awarded: choice of the private partners • Total investment : € 168 million (VAT included) • Public contribution: No public contribution ex ante

  14. Concession Notice: UTFP regulatory advices Risk assessment procedure: the new approach in the concession notice A greater attention to risk assessment procedures through specific additional requirements apart from those provided by law. In particular, the promoters taking part in the bidding process had to: 1) Provide information on risks • Present a matrix of risks; • Specify who is taking each risk; • Specify in which contract clause the risk is managed and how; • Specify the mitigation instruments provided. The risk matrix prepared by the promoter and agreed on by the administration presents the following structures: • Design of the project (6 risks) • Constructions (30 risks) • Management phase (12 risks) • Costs of management phase (6 risks) • Revenues (8 risks) • Resolution of the contract (6 risks) • Technology (2 risks) • Return of the infrastructure (1 risk) • Other risks (12 risks)

  15. Concession Notice: UTFP regulatory advices (2) Other tips by UTFP for better valuation of the bids in concession notice 2) Present a Financial plan making a distinction between the costs of services + VAT and the charge required for the coverage of construction costs. 3) Present the electronic version of the Financial Plan. 4) Present a validation of the project’s input from the certifying bank

  16. CONTACTS UNITA’ TECNICA FINANZA di PROGETTO Presidency of the CouncilofMinisters Head Office - Via della Mercede, 9 – 00187 Rome, Italy Tel. +39 06 6779 6512 – Fax. +39 06 6779 6573 – www.utfp.it Massimo Ricchi–Lawyer and memberof UTFP Tel. +39 06 6779 6520 Mob. +39 347 225 3268 E-mail: m.ricchi@governo.it

More Related