DOCSLIB.ORG

Heather Whiteside

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Heather Whiteside THE PATHOLOGY OF PROFITABLE PARTNERSHIPS: DISPOSSESSION, MARKETIZATION, AND CANADIAN P3 HOSPITALS by Heather Whiteside M.A. (Political Economy), Carleton University, 2006 B.A. (Global Political Economy), University of Manitoba, 2004 THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY in the Department of Political Science Faculty of Arts and Social Sciences Heather Whiteside 2013 SIMON FRASER UNIVERSITY Summer 2013 All rights reserved. However, in accordance with the Copyright Act of Canada, this work may be reproduced, without authorization, under the conditions for “Fair Dealing.” Therefore, limited reproduction of this work for the purposes of private study, research, criticism, review and news reporting is likely to be in accordance with the law, particularly if cited appropriately. Approval Name: Heather Whiteside Degree: Doctor of Philosophy (Political Science) Title of Thesis: The Pathology of Profitable Partnerships: Dispossession, marketization, and Canadian P3 hospitals Examining Committee: Chair: Douglas Ross, Professor Department of Political Science Stephen McBride Senior Supervisor Professor Marjorie Griffin Cohen Supervisor Professor Patrick Smith Supervisor Professor John Calvert Internal Examiner Associate Professor, Faculty of Health Sciences Christopher Stoney External Examiner Associate Professor, School of Public Policy & Administration Carleton University Date Defended/Approved: June 3, 2013 ii Partial Copyright Licence iii Ethics Statement The author, whose name appears on the title page of this work, has obtained, for the research described in this work, either: a. human research ethics approval from the Simon Fraser University Office of Research Ethics, or b. advance approval of the animal care protocol from the University Animal Care Committee of Simon Fraser University; or has conducted the research c. as a co-investigator, collaborator or research assistant in a research project approved in advance, or d. as a member of a course approved in advance for minimal risk human research, by the Office of Research Ethics. A copy of the approval letter has been filed at the Theses Office of the University Library at the time of submission of this thesis or project. The original application for approval and letter of approval are filed with the relevant offices. Inquiries may be directed to those authorities. Simon Fraser University Library Burnaby, British Columbia, Canada update Spring 2010 Abstract Public-private partnerships (P3s) are increasingly used in jurisdictions across Canada to deliver public infrastructure and services. The need for new or redeveloped hospital infrastructure in particular has made this a leading avenue for P3 proliferation. The objective of this study is to analyze P3 policy and projects, principally in relation to the BC and Ontario provincial health sectors. The central arguments made are threefold: P3s are a unique form of accumulation by dispossession and public sector marketization; P3 projects are intrinsically unable to meet the promises made by proponents and carry several other negative social consequences beyond this; and P3 policy, though rooted in normative ideological assumptions and aspirations, is being normalized in BC and Ontario through the establishment of P3 enabling fields over the past decade. The concept of an ‘enabling field’ captures a constellation of new arrangements, notably capital planning procedures and legislative frameworks, supportive secondary reforms, and greater institutional support for privatization. Together these elements help routinize, institutionalize, and depoliticize P3 policy. Canada’s pioneering full spectrum P3 hospitals (where the private partner is charged with designing, building, operating, and financing the facility) are examined in detail: in BC, the Abbotsford Regional Hospital and Cancer Centre and the Gordon and Leslie Diamond Health Care Centre; and in Ontario, the Brampton Civic Hospital and the Royal Ottawa Hospital. These cases reveal the troubling results that policy normalization ignores: poor value for money and inadequate risk transfer, misleading claims of ‘on time and on budget’ delivery, an erosion of service quality and working conditions, and opaque partnership agreements that offer little by way of accountability and transparency. These findings challenge the assumptions and rhetoric of P3 proponents, and offer different examples of how dispossession and marketization manifest in the public health care system. Keywords: Public-private partnership; P3 enabling field; accumulation by dispossession; marketization; neoliberalism; Canada iv Acknowledgements The compliments and criticisms owed to any sole-authored piece are enjoyed by that author alone but a multi-year project such as a PhD thesis can come together only with the visible and invisible help of many others along the way. To my dear family and friends, thank you for all your unwavering support over the years (the many years!). Whether it was direct engagement with the processes and issues that brought this project to completion or whether it was not being involved in any way, offering me the space needed to gain perspective on and distance from the topics explored here, your assistance must not go unacknowledged. To my dissertation committee, examining committee, and other students, faculty, and staff at SFU (across several departments), you too have made all the difference. Marjorie Griffin Cohen also provided me with indispensable research opportunities which helped build my expertise in a number of political economy-related areas. Stephen McBride, my Senior Supervisor, gave not only his time and patient scrutiny but also his encouragement, advice, and mentorship, supporting my thesis and progress through the PhD program along with my personal and professional growth and development. Grants, scholarships, and fellowships awarded by SFU, the Province of British Columbia, and the Social Sciences and Humanities Research Council proved both timely and crucial. Last, but in no way least, thanks to all those who agreed to be interviewed for this research. It is for those who work (often tirelessly and without acknowledgement or thanks) within, against, and even in support of P3 hospitals that I dedicate this thesis. v Table of Contents Approval .................................................................................................................................. ii Partial Copyright Licence ....................................................................................................... iii Abstract .................................................................................................................................. iv Acknowledgements ................................................................................................................. v Table of Contents ................................................................................................................... vi List of Tables .......................................................................................................................... ix List of Acronyms...................................................................................................................... x Introduction. The pathology of for-profit partnerships: researching and writing about P3s ...........1 Context ...................................................................................................................................2 Objectives & contributions .......................................................................................................5 Research methods ..................................................................................................................9 Chapter summary ..................................................................................................................13 SECTION 1. Examining the political economy of privatization and P3s in Canada ....................16 Chapter 1. Market politics and politics of the market: dispossession, crises, and neoliberal state restructuring ……………………………………………………………………………………………..17 Market politics and politics of the market ...............................................................................19 Crises, fixes, and accumulation by dispossession .............................................................20 Transformations within neoliberalism.................................................................................25 Marketization, dispossession, and P3s ..................................................................................27 Market rule ........................................................................................................................28 Market-like rules ................................................................................................................30 Concluding remarks ..............................................................................................................31 Chapter 2. Partnering for profit: the discourse and practice of public-private partnerships ........33 Justifying public-private partnerships: the illusory nature of cost savings, risk transfer, and value for money.....................................................................................................................34 Cost savings ......................................................................................................................34 Risk transfer
Load more

Recommended publications
  • Social Impact Bonds in Canada: from Theory to Implementation
    SOCIAL IMPACT BONDS IN CANADA: FROM THEORY TO IMPLEMENTATION by Arjun Langford Bachelor of Public Affairs and Policy Management, Specialization: International Studies, Carleton University, 2009 PROJECT SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF PUBLIC POLICY In the Public Policy Program of the Faculty of Arts and Social Sciences © Arjun Langford, 2011 SIMON FRASER UNIVERSITY Term (choose Fall or Spring or Summer) Year All rights reserved. However, in accordance with the Copyright Act of Canada , this work may be reproduced, without authorization, under the conditions for Fair Dealing . Therefore, limited reproduction of this work for the purposes of private study, research, criticism, review and news reporting is likely to be in accordance with the law, particularly if cited appropriately. Approval Name: Arjun Langford Email: [email protected] Degree: Master of Public Policy Title of Project: Social Impact Bonds in Canada: From Theory to Implementation Supervisory Committee: Jonathan R. Kesselman Senior Supervisor Public Policy Program John Richards Supervisor Public Policy Program Date Approved: March 11, 2011 1 Abstract Social impact bonds (SIBs) are a new method of generating private investment for preventative social programming in the UK. SIBs generate investment from private sources for social programs by issuing a contract that pays returns to investors based on a percentage of the savings received by government as a result of the program outcomes. This paper analyzes the theoretical underpinnings of this concept and attempts to determine applicability in a Canadian context. No previous substantive study of this kind has been performed in a Canadian context. This study undertakes empirical research of potential SIB applications in the form of an employment program for persons with disabilities, a social housing program and a preventative healthcare program for hypertension management.
    [Show full text]
  • Public-Private Partnerships: Re-Conceptualizing the ‘Public Interest’
    Public-private partnerships: re-conceptualizing the ‘public interest’ Draft: not for citation without author’s permission Canadian Political Science Association 2013 Annual Conference University of Victoria Victoria, BC June 4-6, 2013 Heather Whiteside1 Abstract Public-private partnerships (P3s) have been present in jurisdictions across Canada since the 1990s but it is only within the past decade (or less) that systematic attempts have been made on the part of government to protect the public interest when developing P3s. This raises three interrelated questions: how is the ‘public interest’ now conceptualized, what types of protections are being offered, and what have been the implications of these reforms? In addressing these issues, this paper argues that the P3 phenomenon relies on a fundamental reorientation and marketization of the public interest. Key components of this process include the methods now used to make infrastructure planning decisions (including how value for money is assessed and risk is gauged) and the empowering of new public sector agencies geared strictly toward privatization. Attempts to protect the public interest are therefore more attuned to facilitating P3s and streamlining privatization processes than they are to improving social outcomes, broadly conceived. Public-private partnerships (P3s)2 have been present in jurisdictions across Canada since the 1990s but it is only within the past decade (or less) that systematic attempts have been made on the part of government to protect the public interest when developing P3s. Protections are sorely needed given the poor track record of P3s in Canada: these projects are frequently unable to meet the promises made by proponents and carry several other negative social consequences (Whiteside 2011; 2013a; 2013b).
    [Show full text]
  • Using Public-Private Partnerships to Improve Transportation Infrastructure in Canada by Charles Lammam, Hugh Macintyre, and Joseph Berechman
    Studies in Economic Prosperity May 2013 Using Public-Private Partnerships to Improve Transportation Infrastructure in Canada by Charles Lammam, Hugh MacIntyre, and Joseph Berechman Contents Executive summary / iii Introduction / 1 1 What are Public-Private Partnerships? / 3 2 The benefits of Public-Private Partnerships / 11 3 Common concerns about Public-Private Partnerships / 23 4 Conditions for successful Public-Private Partnerships / 31 5 Measuring the extent of transportation Public-Private Partnerships in Canada / 37 Conclusion / 44 Appendix A: Information on individual Canadian transportation P3s from 1985 to 2013 (as of Jan. 30) / 47 Appendix B: A description of PWF’s International Major Projects Database / 51 References / 53 About the authors / 62 Acknowledgments / 63 Publishing information / 64 Supporting the Fraser Institute / 65 Purpose, funding, & independence / 66 About the Fraser Institute / 67 Editorial Advisory Board / 68 fraserinstitute.org / i ii / fraserinstitute.org Executive summary There is general agreement among diverse groups and individuals that Canada’s transportation infrastructure desperately requires improvement. As governments move to confront this challenge, it is not enough that they simply commit to building more roads or bridges; the infrastructure must be built on time and on budget, be of high quality, and be well-maintained. The conventional way for providing transportation infrastructure involves the government hiring a firm to build the facility based on a pre- scriptive design. The government then takes responsibility for operating and maintaining the facility and perhaps outsources some aspects of care to pri- vate companies. With a history of construction-cost overruns and time delays as well as other notable problems, the conventional process has not served Canadians well.
    [Show full text]
  • Moving Forward on Public Private Partnerships: U.S
    BROOKINGS-ROCKEFELLER Project on State and Metropolitan Innovation Moving Forward on Public Private Partnerships: U.S. and International Experience with PPP Units Emilia Istrate and Robert Puentes Summary In a time of constrained public budgets, leveraging private-sector financial resources and exper- “ Dedicated tise to deliver a range of infrastructure projects has growing appeal. However, these public/pri- vate partnerships (PPPs) are often complicated contracts that differ significantly from project to PPP units help project and from place to place. In the United States, many states lack the technical capacity and expertise to consider such deals and fully protect the public interest. To address this problem, governments countries, states, and provinces around the world have created specialized institutional enti- ties—called PPP units—to fulfill different functions such as quality control, policy formulation, and develop and technical advice. This report recommends that U.S. states should: expedite the PPP n Establish dedicated PPP units to tackle bottlenecks in the PPP process and protect the public interest market, while at n Pass legislation and change the procurement culture to a more transparent and outcome- based project selection process the same time n Work with the federal government to address technical assistance gaps on PPPs, on an as-needed basis protecting the public interest.” I. Introduction ith its emphasis on consumption rather than production, the Great Recession un- veiled an American economy dangerously out-of-whack. During the sluggish recovery that has followed, national, state, and metropolitan public and private sector leaders continue to push for investments in infrastructure to put Americans back to work and Wrebalance the economy.
    [Show full text]
  • The Case for Public-Private Partnerships in Infrastructure
    Timothy J. Murphy The case for public-private partnerships in infrastructure Abstract: Much of the public debate about public-private partnerships (P3s) has oc- curred through the lens of those who either oppose or support this increasingly popular method of delivering public infrastructure assets. Despite some scepticism in the academic literature, an analysis of the key arguments for and against P3s con- cludes that the P3 model can successfully deliver public infrastructure goods and services, provided that certain key thresholds are met. Lessons learned from early experiments in P3s and from the experience of the newer government P3 procure- ment agencies suggest that P3s can provide value for money if risk is allocated to the party best able to manage it. An appropriate risk allocation requires that governments have the expertise to identify all of the relevant risks before entering into the part- nership contract. Governments must also have the contract management skills to ensure that those risks are in fact borne by the private sector. To maintain public con- fidence in the P3 model, governments must live up to their own obligations of transparency and accountability and not succumb to private-sector demands for con- fidentiality. The article recognizes that not all government goods and services can meet the threshold but that, if they do, it argues strongly for the efficiency and effec- tiveness of the P3 model. Sommaire: Une grande partie du de´bat public au sujet des partenariats entre le secteur public et le secteur prive´ (les P3) a eu lieu par l’entremise de ceux qui opposent ou soutiennent cette me´thode de plus en plus populaire de livrer de l’infrastructure publique.
    [Show full text]
  • Public-Private Partnerships the Canadian Experience
    The Canadian Council for Public - P r i v a t e Partnerships Public-Private Partnerships The Canadian Experience Mark Romoff President & Chief Executive Officer The Expanding World of Overseas PPP: New Opportunities for Japanese Investors/Participants Tokyo, May 22, 2014 Infrastructure Investment The Global Challenge 2 Global Infrastructure Deficit $57 trillion Roads $16.6 TN Power $12.2 TN Water $11.7 TN Telecommunications $9.5 TN Rail $4.5 TN Airports $2.0 TN Ports $0.7 TN Source: McKinsey Global Institute, “Infrastructure productivity: How to save $1 trillion a year”, January 2013 3 Infrastructure Investment • Drives Jobs • Drives Growth + Prosperity • Drives Global Competitiveness But some realities.... 4 Infrastructure Challenge Infrastructure Deficit + Fiscal Reality ≈ P3 5 Canadian PPP Market 6 Canadian PPP Overview • 20 year history • 209 projects • $64.7+ Billion 7 PPP Projects by Location Province Number Alberta 17 British Columbia 35 Manitoba 4 New Brunswick 10 Newfoundland & Labrador 1 Northwest Territories 1 Nova Scotia 3 Nunavut 2 Ontario 104 Québec 18 Saskatchewan 5 Federal 9 Total 209 8 PPP Projects by Sector Sector Number * Value ($B) ** Transportation 46 28.7 Hospitals & Healthcare 79 20.3 Justice/Corrections 19 5.4 Energy 6 4.3 Education 11 1.7 Recreation & Culture 17 1.4 Real Estate 3 0.9 Defence 1 0.9 Environmental 21 0.6 Government Services 4 0.5 IT Infrastructure 2 0.0 Total 209 64.7+ * Includes projects with committed PPP Canada funding that have not gone to RFQ yet. 9 ** Includes only actual cost figures released
    [Show full text]
  • Public–Private Partnerships Policy and Practice a Reference Guide
    Public–Private Partnerships Policy and Practice A Reference Guide Edited by HK Yong Public–Private Partnerships Policy and Practice i Commonwealth Secretariat Marlborough House Pall Mall London SW1Y 5HX United Kingdom © Commonwealth Secretariat 2010 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic or mechanical, includ- ing photocopying, recording or otherwise without the permission of the publisher. Published by the Commonwealth Secretariat Edited by Wayzgoose Designed by S.J.I. Services, New Delhi Cover design by Tattersall Hammarling and Silk Index by Indexing Specialists (UK) Ltd Printed by Hobbs the Printers Ltd, Totton, Hampshire The draft of this Reference Guide was prepared by Cambridge Economic Policy Asso- ciates Ltd (CEPA), a London-based economic and finance advisory firm (www.cepa.co.uk), for the Commonwealth Secretariat. Views and opinions expressed in this publication are the responsibility of the authors and should in no way be attributed to the institu- tions to which they are affiliated or to the Commonwealth Secretariat. Wherever possible, the Commonwealth Secretariat uses paper sourced from sustain- able forests or from sources that minimise a destructive impact on the environment. Copies of this publication may be obtained from Publications Section Commonwealth Secretariat Marlborough House Pall Mall London SW1Y 5HX United Kingdom Tel: +44 (0)20 7747 6534 Fax: +44 (0)20 7839 9081 Email: [email protected] Web: www.thecommonwealth.org/publications A catalogue record for this publication is available from the British Library. ISBN (paperback): 978-1-84929-020-3 ISBN (e-book): 978-1-84859-069-4 ii Public–Private Partnerships Policy and Practice Foreword Historically, the public sector in Commonwealth countries has been the main pro- vider of basic service delivery and infrastructure.
    [Show full text]
  • Building BC for the 21St Century
    Building BC for the 21st Century A WHITE PAPER ON INFRASTRUCTURE POLICY AND FINANCING October 2014 Table of Contents Highlights ........................................................................................................................................................... i 1. Introduction .............................................................................................................................................. 1 2. Purpose of The Paper ............................................................................................................................... 2 3. Infrastructure Defined .............................................................................................................................. 3 Characteristics of Infrastructure .................................................................................................................. 3 Public versus Private Infrastructure ............................................................................................................. 4 4. The Importance of Infrastructure ............................................................................................................. 6 Well‐being and Quality of Life ..................................................................................................................... 7 The Changing Setting for Investment in Infrastructure ............................................................................... 7 Population ...................................................................................................................................................
    [Show full text]
  • Partnerships British Columbia Service Plan, 2011/12
    Partnerships British Columbia Service Plan 2011/12 - 2013/14 www.partnershipsbc.ca Message from the Chair It is my pleasure to present the Service Plan for Partnerships British Columbia Inc. (Partnerships BC or the company) for the period April 1, 2011 to March 31, 2014. This plan outlines the company’s goals and plans for achieving those goals over the next three fiscal years. This is a time of transition and evolution for Partnerships BC. In October 2010, Sarah Clark was appointed President & CEO marking the conclusion of a well thought-out succession strategy to ensure continuity and consistency for Partnerships BC’s employees, clients and the partnership market. Under Sarah Clark’s leadership, the company will continue to provide expert advice to government to ensure best value for British Columbians. Partnerships BC is a mature organization with eight years of experience supporting the infrastructure and fiscal priorities of the Province. Initially, the primary focus of our company was the growth and development of a robust public private partnership (PPP) market in British Columbia. Over this period, the company has developed expertise and commercial skills that can now be applied more broadly. At the direction of our Shareholder, Partnerships BC is seeking opportunities to leverage its experience and commercial skills to expand its role in the planning, procurement and implementation of capital projects which use a combination of partnership and other procurement methods; and which seek to meet the Province’s energy needs in a more effective and efficient manner. Although British Columbia’s economy is starting to recover from the global recession, there is still the potential for fiscal restraint which could impact the availability of funding for infrastructure projects.
    [Show full text]
  • Public-Private Partnerships (P3s) in Health Care Last Updated: February 2012
    Policy Statement Public-Private Partnerships (P3s) in Health Care Last Updated: February 2012 BCMA Position . British Columbians deserve an effective, efficient, accessible, and publicly funded health system. The BCMA supports the expansion of privately delivered, publicly funded health services provided that these services are delivered efficiently and that high quality care is ensured. Standardized and transparent criteria for assessing whether a public-private partnership (P3) is the most cost- effective option for building health care infrastructure and delivering health care services is a necessary prerequisite to the initiation of any P3. Independent, ongoing evaluations of public-private partnerships are needed to assess total costs, their impact on patient care, wait times, and professional and public satisfaction. These evaluations should be made available to the public. Background 2002, almost $12.5 billion have been invested in more than 35 P3 projects, of which $5 billion comes from 4 A P3 is a contractual arrangement between a payor private capital. For projects with $50 million or more of (usually government) and a private entity for the provincial funding, a P3 will be considered the base case provision of assets and/or the delivery of services. The unless there is a compelling reason to do otherwise. contract allocates responsibilities and risks among the P3 healthcare projects in British Columbia have various partners. Some P3s involve outsourcing or encompassed a variety of care settings, including “contracting out” to the private entity. In others, public building rural and urban hospitals, tertiary care centers, assets are sold to the private entity.1,2 and assisted living facilities.
    [Show full text]
  • Uvic Thesis Template
    Public Sector Capacity to Plan and Deliver Public/Private Infrastructure Partnerships (P3s): A Case Study of British Columbia’s Healthcare Sector by Maurice Rachwalski M.A., University of British Columbia, 1993 B.S.W., University of British Columbia, 1989 B.A., Simon Fraser University, 1985 A Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of DOCTOR OF PHILOSOPHY in the School of Public Administration Maurice Rachwalski, 2013 University of Victoria All rights reserved. This dissertation may not be reproduced in whole or in part, by photocopy or other means, without the permission of the author. ii Supervisory Committee Public Sector Capacity to Plan and Deliver Public/Private Infrastructure Partnerships (P3s): A Case Study of British Columbia’s Healthcare Sector by Maurice Rachwalski M.A., University of British Columbia, 1993 B.S.W., University of British Columbia, 1989 B.A., Simon Fraser University, 1985 Supervisory Committee Dr. John W. Langford, (School of Public Administration) Supervisor Dr. Evert A. Lindquist, (School of Public Administration) Departmental Member Dr. David Scoones, (Department of Economics) Outside Member Dr. Thomas Ross, (Sauder School of Business, University of British Columbia) Additional Member iii Abstract Supervisory Committee Dr. John W. Langford, (School of Public Administration) Supervisor Dr. Evert A. Lindquist, (School of Public Administration) Departmental Member Dr. David Scoones, (Department of Economics) Outside Member Dr. Thomas Ross, (Sauder School of Business, University of British Columbia) Additional Member Sweeping public sector reforms have occurred globally in recent decades. One of the more high profile and contentious strategies pursued in jurisdictions such as Australia, the United Kingdom, and more recently Canada is the radical shift to public- private infrastructure partnerships - commonly referred to in Canada as ‘P3s’.
    [Show full text]
  • Overview of Privatization
    Privatization Overview February 2020 The National Union of Public and General Employees (NUPGE) is a family of 11 Component and 3 affiliate unions. Taken together, we are one of the largest unions in Canada. Most of our 390,000 members work to deliver public services of every kind to the citizens of their home provinces. We also have a large and growing number of members who work for private businesses. Larry Brown, President Bert Blundon, Secretary-Treasurer Introduction By any objective measure, privatizing public services is a failed policy. According to its supporters, privatization was supposed to provide better public services at a lower cost. It has done neither. At best, privatization has meant poorer quality services, higher costs, or both. At worst, it’s been a disaster. P3 privatization schemes have added billions to the cost of schools, hospitals, transit systems, and other infrastructure projects. The secrecy around privatization schemes has led to problems with corruption. When privatization resulted in corners being cut to increase profits, people were forced to do without services or supports they desperately needed. What have allowed privatization to continue in the face of such an appalling track record are the businesses and individuals that make money when public services are privatized. While they would never use the term, the businesses and individuals profiting from privatization have come to form a “privatization industry.” Their response to failures is either to claim problems are specific to particular privatization schemes or to ignore the problems completely. But as problems with privatization have continued to increase, even many supporters have acknowledged things need to change.
    [Show full text]