Breaking New Ground: P3 Hospitals In Canada

Summary

Healthcare infrastructure in Canada is being renewed through the P3 delivery model. With more than 50 P3 hospitals in operation or development, governments, healthcare leaders and communities are seeing the benefits. This report examines the extent of P3 activity across Canada over the last eight years. It includes case studies on seven P3 hospital projects in BC, Quebec and Ontario, as well as the lessons learned and the implications for the future.

Key Findings

• Since 2003 more than 50 hospital P3s valued at over $18 billion have proceeded, and are either in procurement, construction or already in operation. Most of these have been in Ontario, with others in British Columbia, Quebec, and very recently, New Brunswick. Canada’s healthcare infrastructure renewal goals are progressively being realized through the P3 delivery model.
• Canadian provincial infrastructure agencies and hospitals are impressed with the successes of their hospital P3s because they have secured significant benefits, including significant value for money; on-time, on-budget delivery; innovation; and long-term cost certainty.
• P3 hospitals in Canada may be facilitating clinical innovation and improving patient outcomes. Although perhaps a result of new facilities and not the procurement model used, many Canadian P3 hospital procurements exhibit a number of input features that could lead to improved outcomes, including: significant involvement of clinical user groups in planning and design; a strong emphasis on clinical functionality in private sector bid evaluation; robust competition among private sector bidders; and involvement of international experts in hospital planning and design on both the hospital and bidder sides.
• Canada’s three largest infrastructure agencies—Infrastructure Ontario, Infrastructure Quebec and Partnerships BC—have consistently highlighted lessons learned so as to improve the P3 process. These lessons include: a robust approach to assessing project affordability; getting the right people involved; compressing the financial close period; ensuring a fair and transparent bid evaluation; and, focusing on partnership.
• The Canadian healthcare system faces a number of challenges: an aging population, increases in chronic disease, rapidly changing medical technologies and tight budgets. Concentrating acute and specialized care services in larger, centralized facilities allows for more efficient use of technology and medical expertise and leads to better quality of care. In order to address these challenges, P3 models must also evolve.

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