Exploring the Role of and Factors Affecting Public-Private Partnership in Health Care Systems: A Scoping Review
Abstract
Background: Public-private partnerships (PPPs) address issues of access, quality, and innovation in health care. This paper assesses the impact of various PPP models on health care delivery and explores factors influencing their success. We aimed to deepen policymakers’ and practitioners’ understanding of PPP dynamics, challenges, and opportunities.
Methods: A scoping review was conducted using a systematic approach to identify relevant literature on PPPs in health care from 2000 to 2024. Searches were performed in PubMed, Scopus, and Web of Science using specific search terms and inclusion criteria. Data from selected articles were analyzed to identify key themes, drivers, and outcomes related to PPP implementation and impact.
Results: The review covered 37 PPP studies from multiple countries, revealing mixed results and challenges. Successful PPPs in China, Iran, and Kenya improved health care delivery, efficiency, and patient satisfaction. However, challenges such as regulatory barriers, financial constraints, and integration issues persist. In Spain and Portugal, PPPs often face public rejection due to perceived financial unsustainability. Legal and regulatory frameworks in Iran and Tanzania hinder effective PPP implementation.
Conclusion: PPPs have significant potential to transform health systems, especially in resource-limited settings. Their success relies on careful planning, strong governance, and adapting to local contexts. For PPPs to be effective, they must prioritize equity and sustainability in their design and execution.
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2. Tortorella GL, Fogliatto FS, Mac Cawley Vergara A, Vassolo R, Sawhney R (2020). Healthcare 4.0: trends, challenges and research directions. Production Planning & Control, 31 (15):1245-1260.
3. Mallat A, Vrontis D, Thrassou A (2021). Patient satisfaction in the context of public–private partnerships. Int J Organ Anal, 29 (6):1395-1422.
4. Yang J, Nisar TM, Prabhakar GP (2017). Critical success factors for build–operate–transfer (BOT) projects in China. Ir J Manag, 36 (3):147-161.
5. Akhtar M, Mufti NA, Mubin S, Saleem MQ, Zahoor S, Ullah S (2023). Identification of Various Execution Modes and Their Respective Risks for Public–Private Partnership (PPP) Infrastructure Projects. Buildings, 13 (8):1889.
6. Garg S, Garg S (2017). Rethinking public-private partnerships: An unbundling approach. Transp Res Procedia, 25:3789-3807.
7. Sitharamaraju K, Yelne SA, Kumar BS, Narayanaswami S (2020). PPP in Indian railways: models, framework, and policies. ed. Indian Institute of Management, Ahmedabad.
8. Verweij S, van Meerkerk I, Casady CB (2022). The performance advantage of public-private partnerships: does it exist or not? S. Verweij, IF van Meerkerk & CB Casady (red.), Assessing the performance advantage of PPPs: A comparative perspective, Cheltenham: Edward Elgar:1-26.
9. Kim MJ (2023). Toward Coherence: A Space Sector Public-Private Partnership Typology. Space Policy, 64:101549.
10. Cherkos FD, Jha KN, Singh A (2020). Framework to select public–private partnership modalities. J Leg Aff Disput Resolut Eng Constr, 12 (4):04520034.
11. Roehrich JK, Lewis MA, George G (2014). Are public-private partnerships a healthy option? A systematic literature review. Soc Sci Med, 113:110-9.
12. Levac D, Colquhoun H, O'brien KK (2010). Scoping studies: advancing the methodology. Implement Sci, 5:69.
13. Basabih M, Prasojo E, Rahayu AYS (2022). Hospital services under public-private partnerships, outcomes and, challenges: A literature review. J Public Health Res, 11 (3):22799036221115781.
14. Nduhura A, Nuwagaba I, Settumba J, Molokwane T, Lukamba M (2020). Public private partnerships: systematic review of available models for improving health care services. International Conference on Public Administration and Development Alternatives.
15. Adamou M, Kyriakidou N, Connolly J (2021). Evolution of public-private partnership: The UK perspective through a case study approach. Int J Organ Anal, 29 (6):1455-1466.
16. Ferreira DC, Marques RC (2021). Public-private partnerships in health care services: Do they outperform public hospitals regarding quality and access? Evidence from Portugal. Socio-Econ Plan Sci, 73:100798.
17. Kang S, Mulaphong D, Hwang E, Chang C-K (2019). Public-private partnerships in developing countries: Factors for successful adoption and implementation. Int J Public Sect Manag, 32 (4):334-351.
18. Amović G, Maksimović R, Bunčić S (2020). Critical success factors for sustainable public-private partnership (PPP) in transition conditions: An empirical study in Bosnia and Herzegovina. Sustainability, 12 (17):7121.
19. Comendeiro-Maaløe M, Ridao-López M, Gorgemans S, Bernal-Delgado E (2019). Public-private partnerships in the Spanish National Health System: The reversion of the Alzira model. Health Policy, 123 (4):408-411.
20. Ovcharova NV, Grabowska M (2022). Implementation of public-private partnership in the healthcare management system. Health Economics and Management Review, 3 (1):86-95.
21. Strasser S, Stauber C, Shrivastava R, Riley P, O’Quin K (2021). Collective insights of public-private partnership impacts and sustainability: A qualitative analysis. PLoS One, 16 (7):e0254495.
22. Sadeghi A, Barati O, Bastani P, Daneshjafari D, Etemadian M (2020). Feasibility of implementing public–private partnership (PPP) in the development of hospital services and optimizing resource allocation in Iran. Cost Eff Resour Alloc, 18:25.
23. Wright S, Barlow J, Roehrich JK (2019). Public-private partnerships for health services: Construction, protection and rehabilitation of critical healthcare infrastructure in Europe. In: Clark, R.M., Hakim, S. (eds) Public Private Partnerships. Competitive Government: Public Private Partnerships. Springer, Cham.
24. Asadi P, Bavi S, Bajoulvand R, et al (2018). Models of" public-private partnership" and their effects on hospital mid-indicators: a critical review. Journal of Health Administration, 21 (73): 89-105.
25. Khetrapal S, Acharya A, Mills A (2019). Assessment of the public-private-partnerships model of a national health insurance scheme in India. Soc Sci Med, 243:112634.
26. Wang Y, Zhang L (2019). Status of public–private partnership recognition and willingness to pay for private health care in China. Int J Health Plann Manage, 34 (2):e1188-e1199.
27. Ma H, Zeng S, Lin H, Zeng R (2020). Impact of public sector on sustainability of public–private partnership projects. J Constr Eng Manag, 146 (2):04019104.
28. Muhammad Z, Sik KK, Johar F, Sabri S (2016). An overview of critical success factors of public private partnership in the delivery of urban infrastructure and services. Plan Malays, (4).
29. Shadpour P, Barzegar M, Afzal E (2013). Study on the impact of implementing public-private partnership (PPP) at Hasheminejad Kidney Center. Int J Hosp Res, 2 (4):195-200.
30. Barzegar M, Tabibi SJ, Maleki MR, Nasiripour AA (2016). Designing a Public-Private Partnership Model for Public Hospitals in Iran. Int J Hosp Res, 5 (1):41-45.
31. Hellowell M (2016). The price of certainty: Benefits and costs of public–private partnerships for healthcare infrastructure and related services. Health Serv Manage Res, 29 (1-2):35-39.
32. Nzioka WM, Njoroge K, Kyalo CK (2023). Influence of public-private partnership on healthcare service delivery in Nairobi County, Kenya. IAJHMN, 2 (1):341-362.
33. Rodrigues NJP, Carvalho JM (2023). Public-private partnership in the Portuguese health sector. Heliyon, 9 (8): e19122.
34. Castelblanco G, Safari P, De Marco A (2023). Driving Factors of Concession Period in Healthcare Public Private Partnerships. Buildings, 13 (10):2452.
35. Luo Z, Li J, Wu Z, Li S, Bi G (2022). Investigating the Driving Factors of Public Participation in Public-Private Partnership (PPP) Projects—A Case Study of China. Int J Environ Res Public Health, 19 (9):5192.
36. Joudyian N, Doshmangir L, Mahdavi M, Tabrizi JS, Gordeev VS (2021). Public-private partnerships in primary health care: a scoping review. BMC Health Serv Res, 21 (1):4.
37. Ahmad U, Waqas H, Akram K (2021). Relationship between project success and the success factors in public–private partnership projects: A structural equation model. Cogent Bus Manag, 8 (1):1927468.
38. Nuhu S, Mpambije CJ, Ngussa K (2020). Challenges in health service delivery under public-private partnership in Tanzania: stakeholders’ views from Dar es Salaam region. BMC Health Serv Res, 20: 765.
39. Tabrizi JS, Azami-Aghdash S, Gharaee H (2020). Public-private partnership policy in primary health care: a scoping review. J Prim Care Community Health, 11:2150132720943769.
40. Yang J, Song L, Yao X, et al (2020). Evaluating the intention and behaviour of private sector participation in healthcare service delivery via public-private partnership: evidence from China. J Healthc Eng, 2020: 5834532.
41. Gharaee H, Tabrizi JS, Azami-Aghdash S, et al (2019). Analysis of public-private partnership in providing primary health care policy: an experience from Iran. J Prim Care Community Health, 10:2150132719881507.
42. Maosa RO, Muturi WM (2019). Factors Influencing Performance Of Public-Private Partnerships In Healthcare Provision In Kenya; The Case Of Nyamira County. IJSSIT, 5 (5):202-213.
43. Kosycarz EA, Nowakowska BA, Mikołajczyk MM (2019). Evaluating opportunities for successful public–private partnership in the healthcare sector in Poland. J Public Health, 27:1-9.
44. Fabre A, Straub S (2019). The economic impact of public private partnerships (PPPs) in infrastructure, health and education: A review. Toulous School of Economics. Working paper, (986): 1-108.
45. Comendeiro-Maaløe M, Ridao-López M, Gorgemans S, Bernal-Delgado E (2019). A comparative performance analysis of a renowned public private partnership for health care provision in Spain between 2003 and 2015. Health Policy, 123 (4):412-418.
46. Al-Hanawi MK, Qattan AM (2019). An analysis of public-private partnerships and sustainable health care provision in the Kingdom of Saudi Arabia. Health Serv Insights, 12:1178632919859008.
47. Sadeghi A, Barati O, Bastani P, et al (2016). Experiences of selected countries in the use of public-private partnership in hospital services provision. J Pak Med Assoc, 66 (11):1401-1406.
48. Nikjoo RG, Beyrami HJ, Jannati A, et al (2012). Prioritizing public-private partnership models for public hospitals of Iran based on performance indicators. Health Promot Perspect, 2 (2):251-264.
49. Sciulli N (2008). Public private partnerships: an exploratory study in health care. Asian Rev Account, 16 (1):21-38.
50. Fanelli S, Salvatore FP, De Pascale G, Faccilongo N (2020). Insights for the future of health system partnerships in low-and middle-income countries: a systematic literature review. BMC Health Serv Res, 20 (1):571.
51. Okeke C, Eigbiremolen GO, Uzochukwu B, et al (2022). The Role of Contextual Factors in Private Sector Engagement: A Case Study of Private Sector Contribution to COVID-19 Mitigation in Nigeria. Front Public Health,10:915330.
52. McGuire CM, Kaiser JL, Vian T, et al (2024). Learning from the end of the public-private partnership for Lesotho’s National Referral Hospital network. Ann Glob Health, 90 (1):19.
53. Salehi-Amiri A SA (2019). Challenges of PPP in Iran's infrastructure projects: A case study. J Constr Eng Manag, 145 (5):04019026.
54. Eslami S ZJ (2021). Institutional barriers to PPPs in Iran: A health sector perspective. Int J Health Plann Manage, 36 (3):835-848.
55. Ahmadi-Javid A MS (2020). Barriers to public-private partnership implementation in Iran's healthcare system. Health Policy, 124 (8):850-858.
56. Mirzabeigi M NM (2022). Recommendations for improving PPP frameworks in Iran. Public Adm Rev, 82 (4):720-729.
57. Dehghan A SM (2021). Financial and regulatory reforms to support PPP projects in Iran. Journal of Public Budgeting Accounting and Financial Management, 33 (1):67-82.
58. Grimsey D LM (2005). Are Public Private Partnerships value for money? Evaluating alternative approaches and comparing academic and practitioner views. Account Forum, 29 (4):345-378.
59. ER Y (2018). PPPs for Infrastructure: Public-Private Partnerships for Infrastructure: Principles of Policy and Finance. Amazon.
60. Najafi M M-AZ (2018). Evaluating PPP project outcomes in developing countries: The case of Iran. Journal of Data Analysis, 52 (2):119-136.
61. Hosseini M GR (2023). Status of PPP projects in Iran’s health sector: Lessons learned. Int J Health Serv, 53 (1):45-57.
2. Tortorella GL, Fogliatto FS, Mac Cawley Vergara A, Vassolo R, Sawhney R (2020). Healthcare 4.0: trends, challenges and research directions. Production Planning & Control, 31 (15):1245-1260.
3. Mallat A, Vrontis D, Thrassou A (2021). Patient satisfaction in the context of public–private partnerships. Int J Organ Anal, 29 (6):1395-1422.
4. Yang J, Nisar TM, Prabhakar GP (2017). Critical success factors for build–operate–transfer (BOT) projects in China. Ir J Manag, 36 (3):147-161.
5. Akhtar M, Mufti NA, Mubin S, Saleem MQ, Zahoor S, Ullah S (2023). Identification of Various Execution Modes and Their Respective Risks for Public–Private Partnership (PPP) Infrastructure Projects. Buildings, 13 (8):1889.
6. Garg S, Garg S (2017). Rethinking public-private partnerships: An unbundling approach. Transp Res Procedia, 25:3789-3807.
7. Sitharamaraju K, Yelne SA, Kumar BS, Narayanaswami S (2020). PPP in Indian railways: models, framework, and policies. ed. Indian Institute of Management, Ahmedabad.
8. Verweij S, van Meerkerk I, Casady CB (2022). The performance advantage of public-private partnerships: does it exist or not? S. Verweij, IF van Meerkerk & CB Casady (red.), Assessing the performance advantage of PPPs: A comparative perspective, Cheltenham: Edward Elgar:1-26.
9. Kim MJ (2023). Toward Coherence: A Space Sector Public-Private Partnership Typology. Space Policy, 64:101549.
10. Cherkos FD, Jha KN, Singh A (2020). Framework to select public–private partnership modalities. J Leg Aff Disput Resolut Eng Constr, 12 (4):04520034.
11. Roehrich JK, Lewis MA, George G (2014). Are public-private partnerships a healthy option? A systematic literature review. Soc Sci Med, 113:110-9.
12. Levac D, Colquhoun H, O'brien KK (2010). Scoping studies: advancing the methodology. Implement Sci, 5:69.
13. Basabih M, Prasojo E, Rahayu AYS (2022). Hospital services under public-private partnerships, outcomes and, challenges: A literature review. J Public Health Res, 11 (3):22799036221115781.
14. Nduhura A, Nuwagaba I, Settumba J, Molokwane T, Lukamba M (2020). Public private partnerships: systematic review of available models for improving health care services. International Conference on Public Administration and Development Alternatives.
15. Adamou M, Kyriakidou N, Connolly J (2021). Evolution of public-private partnership: The UK perspective through a case study approach. Int J Organ Anal, 29 (6):1455-1466.
16. Ferreira DC, Marques RC (2021). Public-private partnerships in health care services: Do they outperform public hospitals regarding quality and access? Evidence from Portugal. Socio-Econ Plan Sci, 73:100798.
17. Kang S, Mulaphong D, Hwang E, Chang C-K (2019). Public-private partnerships in developing countries: Factors for successful adoption and implementation. Int J Public Sect Manag, 32 (4):334-351.
18. Amović G, Maksimović R, Bunčić S (2020). Critical success factors for sustainable public-private partnership (PPP) in transition conditions: An empirical study in Bosnia and Herzegovina. Sustainability, 12 (17):7121.
19. Comendeiro-Maaløe M, Ridao-López M, Gorgemans S, Bernal-Delgado E (2019). Public-private partnerships in the Spanish National Health System: The reversion of the Alzira model. Health Policy, 123 (4):408-411.
20. Ovcharova NV, Grabowska M (2022). Implementation of public-private partnership in the healthcare management system. Health Economics and Management Review, 3 (1):86-95.
21. Strasser S, Stauber C, Shrivastava R, Riley P, O’Quin K (2021). Collective insights of public-private partnership impacts and sustainability: A qualitative analysis. PLoS One, 16 (7):e0254495.
22. Sadeghi A, Barati O, Bastani P, Daneshjafari D, Etemadian M (2020). Feasibility of implementing public–private partnership (PPP) in the development of hospital services and optimizing resource allocation in Iran. Cost Eff Resour Alloc, 18:25.
23. Wright S, Barlow J, Roehrich JK (2019). Public-private partnerships for health services: Construction, protection and rehabilitation of critical healthcare infrastructure in Europe. In: Clark, R.M., Hakim, S. (eds) Public Private Partnerships. Competitive Government: Public Private Partnerships. Springer, Cham.
24. Asadi P, Bavi S, Bajoulvand R, et al (2018). Models of" public-private partnership" and their effects on hospital mid-indicators: a critical review. Journal of Health Administration, 21 (73): 89-105.
25. Khetrapal S, Acharya A, Mills A (2019). Assessment of the public-private-partnerships model of a national health insurance scheme in India. Soc Sci Med, 243:112634.
26. Wang Y, Zhang L (2019). Status of public–private partnership recognition and willingness to pay for private health care in China. Int J Health Plann Manage, 34 (2):e1188-e1199.
27. Ma H, Zeng S, Lin H, Zeng R (2020). Impact of public sector on sustainability of public–private partnership projects. J Constr Eng Manag, 146 (2):04019104.
28. Muhammad Z, Sik KK, Johar F, Sabri S (2016). An overview of critical success factors of public private partnership in the delivery of urban infrastructure and services. Plan Malays, (4).
29. Shadpour P, Barzegar M, Afzal E (2013). Study on the impact of implementing public-private partnership (PPP) at Hasheminejad Kidney Center. Int J Hosp Res, 2 (4):195-200.
30. Barzegar M, Tabibi SJ, Maleki MR, Nasiripour AA (2016). Designing a Public-Private Partnership Model for Public Hospitals in Iran. Int J Hosp Res, 5 (1):41-45.
31. Hellowell M (2016). The price of certainty: Benefits and costs of public–private partnerships for healthcare infrastructure and related services. Health Serv Manage Res, 29 (1-2):35-39.
32. Nzioka WM, Njoroge K, Kyalo CK (2023). Influence of public-private partnership on healthcare service delivery in Nairobi County, Kenya. IAJHMN, 2 (1):341-362.
33. Rodrigues NJP, Carvalho JM (2023). Public-private partnership in the Portuguese health sector. Heliyon, 9 (8): e19122.
34. Castelblanco G, Safari P, De Marco A (2023). Driving Factors of Concession Period in Healthcare Public Private Partnerships. Buildings, 13 (10):2452.
35. Luo Z, Li J, Wu Z, Li S, Bi G (2022). Investigating the Driving Factors of Public Participation in Public-Private Partnership (PPP) Projects—A Case Study of China. Int J Environ Res Public Health, 19 (9):5192.
36. Joudyian N, Doshmangir L, Mahdavi M, Tabrizi JS, Gordeev VS (2021). Public-private partnerships in primary health care: a scoping review. BMC Health Serv Res, 21 (1):4.
37. Ahmad U, Waqas H, Akram K (2021). Relationship between project success and the success factors in public–private partnership projects: A structural equation model. Cogent Bus Manag, 8 (1):1927468.
38. Nuhu S, Mpambije CJ, Ngussa K (2020). Challenges in health service delivery under public-private partnership in Tanzania: stakeholders’ views from Dar es Salaam region. BMC Health Serv Res, 20: 765.
39. Tabrizi JS, Azami-Aghdash S, Gharaee H (2020). Public-private partnership policy in primary health care: a scoping review. J Prim Care Community Health, 11:2150132720943769.
40. Yang J, Song L, Yao X, et al (2020). Evaluating the intention and behaviour of private sector participation in healthcare service delivery via public-private partnership: evidence from China. J Healthc Eng, 2020: 5834532.
41. Gharaee H, Tabrizi JS, Azami-Aghdash S, et al (2019). Analysis of public-private partnership in providing primary health care policy: an experience from Iran. J Prim Care Community Health, 10:2150132719881507.
42. Maosa RO, Muturi WM (2019). Factors Influencing Performance Of Public-Private Partnerships In Healthcare Provision In Kenya; The Case Of Nyamira County. IJSSIT, 5 (5):202-213.
43. Kosycarz EA, Nowakowska BA, Mikołajczyk MM (2019). Evaluating opportunities for successful public–private partnership in the healthcare sector in Poland. J Public Health, 27:1-9.
44. Fabre A, Straub S (2019). The economic impact of public private partnerships (PPPs) in infrastructure, health and education: A review. Toulous School of Economics. Working paper, (986): 1-108.
45. Comendeiro-Maaløe M, Ridao-López M, Gorgemans S, Bernal-Delgado E (2019). A comparative performance analysis of a renowned public private partnership for health care provision in Spain between 2003 and 2015. Health Policy, 123 (4):412-418.
46. Al-Hanawi MK, Qattan AM (2019). An analysis of public-private partnerships and sustainable health care provision in the Kingdom of Saudi Arabia. Health Serv Insights, 12:1178632919859008.
47. Sadeghi A, Barati O, Bastani P, et al (2016). Experiences of selected countries in the use of public-private partnership in hospital services provision. J Pak Med Assoc, 66 (11):1401-1406.
48. Nikjoo RG, Beyrami HJ, Jannati A, et al (2012). Prioritizing public-private partnership models for public hospitals of Iran based on performance indicators. Health Promot Perspect, 2 (2):251-264.
49. Sciulli N (2008). Public private partnerships: an exploratory study in health care. Asian Rev Account, 16 (1):21-38.
50. Fanelli S, Salvatore FP, De Pascale G, Faccilongo N (2020). Insights for the future of health system partnerships in low-and middle-income countries: a systematic literature review. BMC Health Serv Res, 20 (1):571.
51. Okeke C, Eigbiremolen GO, Uzochukwu B, et al (2022). The Role of Contextual Factors in Private Sector Engagement: A Case Study of Private Sector Contribution to COVID-19 Mitigation in Nigeria. Front Public Health,10:915330.
52. McGuire CM, Kaiser JL, Vian T, et al (2024). Learning from the end of the public-private partnership for Lesotho’s National Referral Hospital network. Ann Glob Health, 90 (1):19.
53. Salehi-Amiri A SA (2019). Challenges of PPP in Iran's infrastructure projects: A case study. J Constr Eng Manag, 145 (5):04019026.
54. Eslami S ZJ (2021). Institutional barriers to PPPs in Iran: A health sector perspective. Int J Health Plann Manage, 36 (3):835-848.
55. Ahmadi-Javid A MS (2020). Barriers to public-private partnership implementation in Iran's healthcare system. Health Policy, 124 (8):850-858.
56. Mirzabeigi M NM (2022). Recommendations for improving PPP frameworks in Iran. Public Adm Rev, 82 (4):720-729.
57. Dehghan A SM (2021). Financial and regulatory reforms to support PPP projects in Iran. Journal of Public Budgeting Accounting and Financial Management, 33 (1):67-82.
58. Grimsey D LM (2005). Are Public Private Partnerships value for money? Evaluating alternative approaches and comparing academic and practitioner views. Account Forum, 29 (4):345-378.
59. ER Y (2018). PPPs for Infrastructure: Public-Private Partnerships for Infrastructure: Principles of Policy and Finance. Amazon.
60. Najafi M M-AZ (2018). Evaluating PPP project outcomes in developing countries: The case of Iran. Journal of Data Analysis, 52 (2):119-136.
61. Hosseini M GR (2023). Status of PPP projects in Iran’s health sector: Lessons learned. Int J Health Serv, 53 (1):45-57.
| Files | ||
| Issue | Vol 54 No 12 (2025) | |
| Section | Review Article(s) | |
| Keywords | ||
| Public-private partnerships Healthcare services Partnership models Scoping review | ||
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How to Cite
1.
Yekehbash M, Zarei R, Joulaei H. Exploring the Role of and Factors Affecting Public-Private Partnership in Health Care Systems: A Scoping Review. Iran J Public Health. 2025;54(12):2623-2633.
