The idea that the private sector, thanks to its efficiency and management skills, can build and run a public hospital, or manage an existing public hospital, is beguiling.  It is also increasingly clear that it is a bird which never flies.

This week we report on the fate which is set to overcome the Alzira model in its home country, Spain, in its home region, Valencia.  The concessions which run for 18-25 years and provide healthcare to over 1m now face a hostile, leftist government keen to dismantle them.  That is despite the fact that these concessions deliver high quality care, often at a 15% saving to the public sector equivalent.

Elsewhere, we have already seen similar failures. In the UK, Circle Health pulled out of Hinchingbrooke Hospital ahead of a damning report which alleges it failed to deliver the right care.  Sources close to Circle allege that bureaucrats who detest the private sector were behind this move.  The NHS claims that the private sector is incapable of delivering.

Meanwhile, in Chile the new leftist government has decided to move against private operators running hospital concessions.  We saw the same in 2009 in Hungary, where an operator was forced into bankruptcy.

So one problem is that these projects are often political footballs.  It is telling that there is no academic consensus. Academics on the left find plenty of evidence to suggest they do not work. Academics on the right claim that they do.

And there are other problems. Firstly, the operator is entirely dependent on a state payor who can always find reasons to delay or reduce payments.  Secondly, often the projects are dreamt up by politicians and property developers and do not meet local needs in any way.

One of the few successful example’s is operator Capio which runs St Gorans hospital in Sweden. But to renew the contract, it had to bid low. Margins are not exciting, we are told.

In Mexico, Jaime Cervantes Covarrubias CEO of Vitalmex, which successfully runs surgery units in public hospitals, says that most of the new operator-led PPP hospitals have 20% bed occupancy rates.  We think that Turkey’s hugely ambitious hospital building programme will prove unpopular with patients forced to travel for hours to attend the new white elephants, as their dilapidated local hospitals are closed.

The lesson is clear. Hospital privatisation – yes. Treating public sector patients in your private hospital – yes. Taking over and running a public hospital – no, never, not on your Nelly. It never works.