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Public-private partnerships in health: exploring origins and implications

Linsey McGoey
(University of Essex)

This paper draws on the history of ideas in order to investigate early 20th-century shifts in economic thought that have led to widespread 21st-century assumptions about the effectiveness of private-sector actors in improving health outcomes. Firstly, I explore the legacy of the ‘socialist calculation debate,’ with particular reference to the epistemological arguments made by Friedrich Hayek. I then situate the emergence of public-private partnerships (PPPs) in global health in a longer historical debate over the relative efficacy of private actors in allocating resources efficiently.

Drawing on the empirical example of advance market commitments (AMCs) in health, I suggest that the evidence-base attesting to the economic and social benefits of subsidizing private-sector actors to help realize global health goals is far weaker than proponents of increased PPPs typically acknowledge.  Somewhat counterintuitively, the problem of a lack of evidence is fuelled by exact phenomenon that currently eludes critical scrutiny: the heightened role of private actors in health. Lastly, I argue that this apparent weakness – the difficulty in obtaining empirical evidence of private-sector efficacy and cost-effectiveness – functions as a rhetorical asset for private actors rather than, as might be expected, a liability.