PPP in the Portuguese Health Sector: Contractual compliance assessment

Since 2001, in Portugal, constant reforms in hospital management have convoyed the transformations in the management models applied to public administration, aiming to ensure a higher quality of services and, concurrently, a more significant economic efficiency by applying the best contract management practices. This study aims to analyze, for the period between 2012 and 2021, the contract management evaluation of the PPP model in the Portuguese hospitals. It was used a mixed research approach based on multiple case studies and archival research. As main results, it was found that: i) production levels of the four PPP hospitals complied with the contractual stipulations; and ii) the State is inefficient in fulfilling its role as supervisor of the services provided throughout PPP management model and is unable to analyze the results obtained by the PPP project lifecycle. This study concluded that over the last 10 years, the Portuguese state should had taken advantage of all the experience gained from the four PPP projects and applying this experience to the PMH hospitals. Not only has the state failed to perform the tasks of supervising and monitoring the PPP model in an effective manner, which has prevented it from acquiring new competencies in terms of management, but it has also failed to adjust the level of service required of the PMH hospitals to that required of the PPP hospitals.