The Pathology of Profitable Partnerships: Dispossession, Marketization, and Canadian P3 Hospitals

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.