## 3 Results and Discussion
### Topic 3: Innovative Models of Healthcare Delivery
#### 3.4.2 Public-Private Partnerships  
A public-private partnership (PPP) may be proposed as a means of facilitating improved access in smaller rural and remote communities whilst also managing the associated costs. The Institute for Global Health Sciences [56] provides a framework for healthcare PPPs, with key characteristics of PPPs being a long-term contract (a suggested minimum of 5+ years, but typically 15+), shared risk, mutually agreed performance indicators, and public ownership of assets at the end of the contract. Different models may be used depending on whether the model seeks to build/refurbish existing infrastructure (infrastructure-based models) or increase service delivery capacity (discrete clinical service models) or is a combination of infrastructure and capacity building (integrated models). Once the proposed model and the need for the PPP have been established, stages include considering delivery options via feasibility/economic studies, issuing a competitive tender process, and awarding the contract (including negotiating terms and securing funding), after which operations commence. It is also highlighted in the framework that successful PPPs require that the public/private sectors are committed to long-term collaboration, transparency between partners, broad stakeholder engagement, a complete contract which supports changes if required, and public and private sectors having the capacity to deliver [56]. An additional framework specific to the oil and gas industry [57] drew from past examples of healthcare models to provide recommendations for how oil and gas companies can work with local health services. The framework outlines that key stages/considerations included stakeholder consultation/consent, making changes to the health system that could be sustained, and leveraging resources, all of which should occur in distinct phases: data gathering and assessing the situation, situational analysis to determine strengths/weaknesses/feasibility, and forming a strategy which involves joint involvement from the company and local healthcare. [PERSON] et al. [58] further suggest that cooperation between oil and gas companies, local government, and other agencies is essential, that industry can help the public sector meet benchmarks, and that stakeholder consultation should occur early. Despite the availability of various frameworks and recommendations, PPPs for healthcare reveal conflicting outcomes relating to their success or otherwise. Furthermore, much of the evidence is drawn from large-scale projects, such as hospitals, making it difficult to draw clear conclusions relevant to the oil and gas industry. PPPs are proposed as being beneficial, as they combine strengths of both the private (innovation through to entrepreneurship) and public (e.g., responsibility, public accountability) sectors [59]. Infrastructure Partnerships Australia reports that successful PPPs are generally those which can align public/private interests, utilise financial incentives, encourage innovation, and create operational efficiency. Any bids/tenders for PPPs based solely on cost are not advised, but rather innovation and the potential for quality service delivery should be prioritised [60]. On the contrary, a number of groups have raised concerns about PPPs in healthcare, with some going as far as recommending they be abolished entirely [61]. Many argue that given the costs and time associated with contract negotiations, any potential profitability from PPPs is negated. There are also concerns that public and private priorities are incompatible with public healthcare's need to be accountable to stakeholders and communities rather than private organisations [61].