1. Public Private Partnerships Innovation or Profiteering?

2. History of Infrastructure Development 1800-mid 1900s religious, philanthropic, charitable institutions 1948 – National Health Grants Program 1971 – Wind up of National Funding, Provinces and Municipalities take responsibility 1990s – Tax Cuts Agenda, Delayed Infrastructure Programs, Growth of P3s

5. Fiscal Imbalance Decline in federal transfers Downloading of responsibility for infrastructure

8. P3s – What Are They? Public Private Partnerships, also called PFI – Private Finance Initiative, AFMs – Alternative Finance Mechanisms, AFPs – Alternative Finance and Procurement While generically described as partnerships the legal relationship embodied in PPP may be a partnership, joint venture, corporation, lease, management arrangement, trust or other structure All definitions include judgements on the benefits or damage caused by these schemes Proponents – P3s harness innovation and transfer risk Ontario Health Coalition – P3s are simply another term for privatization British Medical Association – PFI is Perfidious Financial Idiocy

9. Models of PPP Privatization BOO – Build Own Operate (Ontario Long Term Care facilities since 1997) BOT – Build Operate Transfer DBFO – Design Build Finance Operate (Brampton & Ottawa P3 hospitals and new P3 hospitals) Concession Lease Corporatization BTO – Build Transfer Operate Lease

10. Ontario Health P3s/Privatization P3 Hospitals – DBFO P3s, DBF P3s Long Term Care Facilities built under Conservative Government 1998-2003 – BOO Private Homecare Contracts brought in under Conservative Government 1997 MRI/CT clinics IT contracts, leasing and concession arrangements, etc.

11. The Claims Harness new investment Not privatization Transfer risk Come in under budget and within timelines Innovate Find efficiencies Public control maintained Separation of strategic control from operation

12. The Problems Higher cost Cuts to services – shrinking scope of public medicare Inflexible contracts Loss of democratic control Legal wrangling/management breakdown Commercialization of public service Shoddy construction/maintenance and safety problems Inequality Creation of new risks Deepening privatization

13. P3s in Operation

17. Public Alternatives to P3s

18. Can We Jump Into P3s and Get Back Out Again? NAFTA Cost Duration

19. Resources www.policyalternatives.ca Funding Hospital Infrastructure: Why P3s Dont Work, and What Will by Lewis Auerbach, Arthur Donner, Douglas D. Peters, Monica Townson, and Armine Yalnizyan www.ontariohealthcoalition.ca Click on Public Private Partnerships www.P3watch.ca