Designing a Public-Private Partnership Model for Public Hospitals in Iran

Background and Objectives: Public-Private Partnership (PPP) is a well-established model to alleviate the risk of investment in health domain. While the model is widely applied in the developed countries, the adoption of the model in many developing countries is hampered partly by the lack of knowledge on dimensions and requirements of its local implementation. The present study, thus, aimed to identify the key aspects of PPP for hospital building in an Iranian context. Methods: A comparative study of PPP implementation in seven pioneer countries revealed 53 elements potentially influencing development of PPP. Using rigorous expert opinion seeking, these elements were refined and adapted with respect to the Iranian context. Based on this information a 38-item questionnaire was designed. The questionnaire was distributed among 220 experts from different health domains, including clinicians of public and private hospitals and policy makers, executives, and authorized advisors from MOHME and various medical universities. The collected data were analyzed using exploratory factors analysis in order to identify factors influencing PPP development. The robustness of the identified factors was further explored by confirmatory factor analysis. Findings: Legislation, policy making, finance, capacity building, and social orientation were identified as the five key dimensions of hospital-building PPP implementation in the Iranian context. Conclusions: Identification of the major dimensions of hospital PPP implementation may help policy-makers to develop effective strategies for promotion of PPP in the Iranian health system.