The MarkeTech Group www.themarketechgroup.com USA The MarkeTech Group, LLC 502 Mace Blvd, Suite 15 Davis, CA 95618 Tele: (+1) 530-792-8400 Fax: (+1) 530-792-8447 France The MarkeTech Group, SARL 3, Rue Emile Péhant 44 000 Nantes Tele: +33 (0)2 72 01 00 80 Fax: +33 (0)2 40 48 29 40

1. 1
minutePrivate/Public Partnerships: How to make them successful
Private/Public partnerships, also referred to as PPP, P3 or P
3
, are business ventures involving a contract between the public sector and
a private entity. As funding of public sector healthcare projects becomes more challenging, hospitals are looking at the private sector to
help finance their investments.
Using its recently launched panel of hospital CEOs in France, The MarkeTech Group (TMTG) held its first C-level webinar addressing
the impact of PPP on hospitals’ purchasing strategies. “Will the influence of PPP continue to grow over the next decade?” is an
important question that both hospitals and industry need to be able to answer to decide their future strategies.
In this edition of the Minute, TMTG explores the impact of PPP and how hospital executives wish to leverage and benefit from PPP.
The origin of the "public-private partnership" concept is rooted in the late 70’s and early 80’s.
The objective was to motivate economic activity. Several countries used PPP to finance the
public sector infrastructure. The healthcare infrastructure is no exception and represents a
significant amount of the projects initiated.
Since the 2008 financial crisis, the rate of PPP projects has slowed down by as much as 40%;
however, many projects are still ongoing.
 Europe: $4 billion in hospital PPP deals in Europe were announced during the first
half of 2010, according to Infrastructure Journal. The biggest deal, €1.5 billion, 700-
bed Karolinska in Stockholm, Sweden, is estimated to be the largest hospital PPP in
the world. Another large project, New Hospital de Vigo, Galicia, Spain is a €375
million, 900-bed hospital.
 North America: British Columbia, Ontario, and Quebec have completed $10 billion in
healthcare PPP projects in the last five years. In 2010, McGill University Hospital
project in Montreal reached financial close. At $1.3 billion, it will be North America’s
largest hospital PPP and is expected to open in 2014. In Mexico, 22 states now have
PPP regulations in place, and the remainders are in the process of approving their
own regulations.
EDITORIAL
ISSUE 1 VOLUME 13 SUMMER 2014
MARKET OVERVIEW
The Rise and Decline of PPP
The MarkeTech Group
The Challenge: To better
understand hospital executives’
needs and rationale for decision-
making to optimize communication,
positioning, messaging and,
ultimately, to better engage and sell
the company’s offering to top level
management across multiple
countries.
Our Solution: In-depth one-on-one
discussions with hospital senior
executives in 11 countries across
Europe, North America, Brazil and
Australia to uncover the underlying
reasons for choice and the relative
influence of different stakeholders in
the decision process for laboratory
diagnostics equipment.. To identify
the appropriate messaging, TMTG
tested a selection of value
statements and evaluated how these
resonated with hospital executives.
The Impact: TMTG identified the
most relevant communication to
direct to hospital senior management
stakeholders.
CASE
STUDY:
How to communicate with
hospital executives

2. 2
Interviewer: Olivier Cotten, TMTG Partner
Q: Before discussing further on how these PPPs affect purchasing and investment,
I would like you to give us your own definition of a PPP.
ON THE HORIZON
What Hospitals need from Vendors
INTERVIEW OF THE SEMESTER
Hospital PPP from the inside
Mr. Bernard Bensadoun (BB),
Managing Director of Nantes Polyclinique
de l’Atlantique
Mr. Yann Bubien (YB),
Managing Director of Angers CHU
Mr. Michel Meignier (MM),
Managing Director of Nantes Bretéché Clinic
Mr. Jean Michel Budet (JMB),
Deputy Managing Director of Assistance Publique
Hopitaux de Marseilles (AP-HM)
BB: In the hospital world, PPP deals can be used either for hospital construction and renovation (e.g., expansion projects), or
operational partnership (e.g., non-medical projects such as central heating, laundry and sterilization, etc.). Operational projects started
when the Hospital, Patient, Health, Territory law (HPST law) was enacted to entice hospitals to improve their economic performance
through infrastructure enhancement.
YB: PPP can be defined as outsourcing of construction and management projects to a private for-profit player. . […] At the end of the
day, this is a type of leasing arrangement over decades (10 to 40 years). This approach is attractive because it helps spread the cost of
large investment over a long period of time. PPP also offer a leverage point to public hospitals that can take advantage of several
private sector advantages: benefitting from more advantageous legal arrangements in market terms, less formal calls for tender, and
more significant expertise, […] The rent approach is enticing, but recent PPP arrangements have often ended in failure or have been
compared to financial “time bombs”, particularly for very large operations.
JMB: PPPs effectively deal with cooperation, but some form of PPP practice already existed before the HPST law. For example, public
service concessions can be considered PPPs. The 2004 law intended to formalize these partnerships to allow construction or logistics
operations to be performed in the hospital market. The first PPP projects have evolved into different forms of partnerships in new areas
such as novel real estate asset management and capital equipment purchases like imaging solutions.
MM: In the past, some partnerships have been catastrophic. These failures can be explained by the lack of experience and perspective
on these partnerships, and cultural differences.
Long version of this interview: Hospital PPP from the Inside
At Stake!
 PPP allow hospitals to optimize costs by
pooling certain activities.
 PPP enable public institutions to benefit
from the advantages of the private sector.
For example, reducing delays in the
procurement process or better access to
legal expertise.
 The French HPST law HPST enables the
joint procurement between a public and
private entity of capital equipment (e.g.,
nuclear medicine PET) to improve the
delivery of care across the country.
So What?
 PPP that are successful today typically involve small-scale projects not
related to the clinical activities. For example, one goal may be to share
some activities like heating or laundry service.
 PPP represent a funding opportunity for the acquisition of new
equipment.
 Following TMTG’s webinar on PPP, we asked a sample of French
Radiologists to tell us what impact they expect PPP to have on the
imaging offerings in their region:
o More than half of the respondents think that PPP have a positive
impact in geographic coverage of diagnostic offerings.
o PPP appear to be an attractive solution to providing greater
access for patients to state-of-the-art diagnostic imaging
technologies.
502 Mace Blvd., Suite 15 3, rue Emile Péhant
Davis, CA 95618 44 000 Nantes - France
PH: +1 530.792.8400 PH: +33 (0)2 72 01 00 83
FX: +1 530.792.8447 FX: +33 (0)2 40 48 29 40
MEASURING the VOICE-OF-CUSTOMER in HEALTHCARE
www.themarketechgroup.com
Facts
 The first PPP that involved large-
scale projects such as the
construction of a new hospital,
ended in failure.
 One of the causes of these failures
was the difficulty in efficiently
operationalizing a clinical setting.
Public clinics and private practices
are difficult to standardize.
 The new law HPST (Hospital,
Patient, Health, and Territory) now
facilitates the realization of smaller
PPPs.