Table 1. Common model of public – private partnership in hospitals.

PPP models	Definition	Sub Models
Service contract	■ The state will pay a private institution to perform certain tasks. These tasks may be performed within or outside the hospital.	■ Clinical services
		■ None clinical services
outsourcing contract	■ The government will pay private institution to management and provide the required services in a health institution or a special section of it. Decisions regarding health care staff’s employment, logistics and purchasing medicines and medical supplies are the responsibility of private institution. The risk of contract-related data such as labor can move to a private institution, but the government remains responsible for capital expenditures.	■ Outsourcing clinical services
		■ Outsourcing none clinical services
Management contract	■ Government will pay a private institution for the management of government hospital to administrative hospital and provide needed services, but specialized decisions of health care staffs employment, logistics and purchasing medicines and medical supplies is done by the government. Commercial risk and the responsibility for capital expenditures remain with government.	-
Leases contract	■ Private institutions pay to the government to rent the public hospital and then be responsible for managing and providing service in this center. Instead, a private firm acquires the right to collect revenue from their performance. In this case, all commercial risks are transformed to private institutions. The government is still responsible for capital expenditures.	-
DBFO(Design, Build, Finance, Operate) contract-PFI(Private Finance Initiative) contract	■ In this model, private sector, which often form alliances, are responsible for providing public services and it undertakes all stages of the hospital. Private sector is responsible for investment, establishment, management, and providing non-clinical services (such as nutrition, laundry, security, parking services, logistics, etc.) But government still will have responsibility for delivering hospital core services. This model’s basic difference with concession model is in the funding ways of two models. In this model’s private funds that are spent for facilities and public duties, reimbursed by the government and not be reimbursed by the final consumer.	-
Concession contract	Public hospital rights will be awarded to private sector. Private institutions with paying fee to the government will operate and, maintains the public hospital. In these types of contracts, capital expenditures will be transferred to private institutions.	■ Build, Owo, Operate Contract(BOO)
	1. BOO CONTRACTS: In this contract, the private sector will take over financing, building, operation, and provide clinical services, non-clinical or both of them. Ownership and control responsibility also will be with the private sector. Private sector will bear construction, investments, commercial risks, without transforming hospital ownership to the public sector at the end of the contract. 2. BOT CONTRACTS: In these contracts, the private sector is responsible for financing, design, building and operation of the public hospital. Ownership and formal control will be with the public sector that will be transferred to this sector the end of the contract period	■ Build. Operate, Transfer Contract(BOT)
Divesture Contract(privatization)	■ In these models, government owned hospitals will be sold to private sector. The property will be transformed private institutions and these institutions will be responsible for providing service and capital expenditures. But governments control a monitoring will be maintained.	-
Concession contract	Public hospital rights will be awarded to private sector. Private institutions with paying fee to the government will operate and, maintains the public hospital. In these types of contracts, capital expenditures will be transferred to private institutions.	■ Build, Own, Operate Contract(BOO)
	1. BOO CONTRACTS: In this contract, the private sector will take over financing, building, operation, and provide clinical services, non-clinical or both of them. Ownership and control responsibility also will be with the private sector. Private sector will bear construction, investments, commercial risks, without transforming hospital ownership to the public sector at the end of the contract. 2. BOT CONTRACTS: In these contracts, the private sector is responsible for financing, design, building and operation of the public hospital. Ownership and formal control will be with the public sector that will be transferred to this sector the end of the contract period	■ Build. Operate, Transfer Contract(BOT)
Divesture Contract (privatization)	■ In these models, government owned hospitals will be sold to private sector. The property will be transformed private institutions and these institutions will be responsible for providing service and capital expenditures. But governments control a monitoring will be maintained.	-