意大利市建设经营转移医院的公共筹资.docx

意大利市建设经营性转移医院的公共筹资Public Financing into Build-Operate-Transfer Hospital Projects in ItalyAbstract: An empirical analysis is presented to investigate the factors that have significant influence on the share of public financing into the total initial investment required to develop build-operate-transfer (BOT) health-care projects. Based on a model describing the main risks associated with public participation in BOT projects, a linear regression analysis has been conducted on a data set of Italian BOT hospital projects to yield implications. Outcomes reveal that the size of investment, the financial strength of the concessionaire, the duration of the concession period, the number of services, and the level of borrowing of the local health-care granting agency are significant factors of the level of public funding. The study confirms that public funding is provided not only to cover the non-self-financing portion of investment but also as a way to undertake a project in periods of scarce public financial resources. The methodology may be useful to refine the decision criteria for determining the level of public funding of a BOT hospital project in order to gain an understanding of the value that could be obtained from funding similar projects. DOI: 10.1061/(ASCE)CO.1943-7862.0000545. 2012 American Society of Civil Engineers.摘要：提出了探讨公共融资需要开发建设经营转让的总初始投资份额显著影响因素的实证分析（BOT）保健项目。基于模型的描述与BOT项目中公众参与的主要风险，线性回归分析得到的数据集上的意大利BOT项目产量的影响进行了医院。结果表明，投资的大小，对特许人的财务实力，租界时期的时间，服务的数量，与地方医疗机构借款发放水平信号的公共筹资水平的重要因素。这项研究证实，公共资金提供不仅覆盖的非自筹资金部分的投资，但也作为一种方式来进行一个项目，在稀缺的公共财政资源。该方法可以提炼确定公共资金的BOT医院项目为了获得价值的认识，可以从类似的项目中获得的资金水平决策准则有用。关键词：10.1061 /（ASCE）co.1943-7862.0000545。2012美国土木工程师学会。CEDB Subject Headings: Build/Operate/Transfer; Financial factors; Project management; Health care facilities; Risk management; Regression analysis; Italy.主题词：建立数据库/操作/转移；财务因素；项目管理；卫生设施；风险管理；回归分析；意大利。Author keywords: Build/operate/transfer; Financial factors; Project management; Health-care facilities; Risk management; Regression analysis.作者关键词：构建/运营/转移；财务因素；项目管理；医疗设施；风险管理；回归分析。IntroductionBuild-operate-transfer (BOT) is a delivery method and financing mechanism to establish a long-term publicprivate partnership (PPP) for the purpose of developing a variety of infrastructure and service facilities. Under the terms of a BOT, and other similar forms of procurement arrangements (e.g., build-lease-transfer, project finance initiative), one or more investors join a special purpose vehicle (SPV) company to finance the design, construction, operations, and maintenance of a public facility for a specified government-granted concession period, at the end of which the ownership of the project is transferred back to the awarding authority. The initial investment is intended to be recovered through revenues from the service provided during the concession period, which is determined to sufficiently pay off the debt incurred and earn an acceptable profit from the project cash flows (Schaufelberger and Wipadapisut 2003; Zhang 2009).简介建设-运营-移交（BOT）是一种输送方法和融资机制，建立长期的公共公私合作（PPP）为目的开发的各种基础设施和服务设施。一个僵尸的条件下，与采购安排其他类似的形式（例如，建立租赁转让、项目融资计划），一个或更多的投资者加入一个特殊目的载体（SPV）公司融资的设计，建设，运营，和公共设施的维护一个指定的政府授予的特许经营期，在最终，该项目的所有权转移给授予的权力。初始投资的目的是通过从特许期间提供服务的收入恢复，这是确定足够偿还的债务和收入从项目的现金流可以接受的利润（schaufelberger和wipadapisut 2003；张2009）。BOT has been recognized as an effective institutional mechanism to facilitate private finance and to leverage the private sectors improved quality and efficiency in public projects (Iyer and Sagheer 2010). Therefore, it allows the development of desirable constructed facilities with limited further public spending on governments budgets and additional public borrowing (Shen and Wu 2005; Algarni et al. 2007).BOT方式已被公认为促进民间金融的一种有效的体制机制和利用私人部门提高质量和效率的公共项目（Iyer和sagheer 2010）。因此，它允许理想的人工设施发展有限公司进一步对政府预算的公共开支和额外的公共借款（沈、吴2005；algarni等人。2007）。In Western Europe, countries have been using various forms of PPP to build infrastructure and are currently implementing BOT for social facility projects, as the United Kingdom has done since the early 1990s (Esty and Sesia 2007).在西欧，国家已经以各种不同形式的PPP基础设施建设和社会设施，目前正在实施的BOT项目，作为英国自上世纪90年代初做（Esty和塞西亚2007）。In particular, some of the most popular applications can be found in the health-care sector. Since the enactment of the BOT contracting/financing mechanism in 1999, Italy has rapidly grown in its use of project finance (PF) to develop health-care constructed facilities. As of May 2009, after only a decade of PF application, Italy was the second largest market in terms of both number and value of investments in health-care PF initiatives, after the United Kingdom and ahead of all other European countries (Amatucci et al. 2010).特别是一些最流行的应用程序可以在卫生保健部门找到。由于BOT合同/融资机制1999的颁布，意大利已在其使用的项目融资发展迅速（PF）开发的保健设施。截至5月2009，只有十年PF应用后，意大利在数量和医疗举措的投资价值方面PF的第二大市场，在英国，超过了所有其他欧洲国家（amatucci等人。2010）。However, despite promises of limited public financing demanded to support BOT projects, financially freestanding privately funded BOT hospitals are rare in Italy owing to the public nature of the health-care fee reimbursement system. That is why the capital structure of most projects requires a considerable share of public funding, on average equal to more than 30% of the initial investment. Typically, investors are responsible for the arrangement of both equity and debt finance for the percentage of the initial investment that can be recovered with a fair profit through net income generated within the operations period, while the non-self financing（自融资） part is paid by the conceding government (Zhang 2005a). In addition, uncertainty and risk related to forecasted project cash flows play an important role in determining the capital structure. Indeed, the portion of investment covered with public funding also depends on the project risk profile and the strategy of allocating risk on the private party (Jin 2010), who will commit lower finance to a PPP project in case of high-risk exposure.然而，尽管有限的公共融资的承诺要求支持BOT项目，财政独立的私人资助的BOT医院是罕见的在意大利由于卫生保健费用报销系统的公共性。这就是为什么大多数项目的资本结构需要相当大的份额的公共资金，平均相当于初始投资的30%以上。通常情况下，投资者负责的初始投资的百分比，可以恢复一个公平的利润通过在操作期间产生的净收益的股权和债务融资安排，而非self financing部分由承认政府支付（张2005）。此外，不确定性和风险相关的预测项目的现金流在确定资本结构中发挥了重要作用。事实上，公共资金投资的部分也取决于项目风险的配置和风险的分配策略，在私人派对（金2010），谁会犯下金融购买力平价项目的情况下，高风险。These aspects of BOT health-care projects have been raising questions among scholars and practitioners regarding how to create a balanced benchmark of public financing to mitigate the private sectors risks in a project. However, the risk factors to be taken into account for determining a fair percent share of public financing to contribute to the capital structure of hospital PF initiatives are still unexplored.这些方面的BOT保健项目已令学者和从业人员就如何创造一个平衡的基准公共融资缓解项目中私营部门的风险。然而，风险因素考虑到确定一个公平的份额的公共融资，有助于资本结构的医院的资本结构的举措仍然未被开发。With the purpose of overcoming the research gap, in this work we present an empirical analysis of Italian BOT hospital projects addressed to answer these questions. On the basis of the assumption that the capital structure and, in particular, the level of public funding is inherently associated with the project risk profile and allocation between the contract parties (Amatucci and Lecci 2006), the analysis explores the main risk factors that might have significant relationships with the ratio of public funding to the total amount of financial resources of a BOT hospital project.在克服研究差距的目的，在本文中我们提出了BOT项目的意大利医院解决回答这些问题的实证分析。在假设资本结构，特别是基础，公共筹资水平本质上是与项目风险和分配合同当事人之间相关（amatucci和lecci 2006），分析了主要的风险因素，可能与公共资金对BOT项目财务资源的医院总金额的比例关系。In the following sections, we first illustrate the background of BOT and the state-of-the-art of BOT projects to develop hospital facilities in Italy. Then, after reviewing pertinent literature, we gain an understanding of the risks involved in a PF capital structure. Finally, we present a linear regression analysis and discuss the results. These findings allow conclusions to be done on the factors that can affect the level of public funding into health-care PPP investments in order to facilitate a more appropriate money-forvalue oriented policy for public spending.在下面的章节中，我们首先说明BOT的背景和BOT项目在意大利开发的医院设施先进。然后，在回顾相关文献，我们获得了一个资本结构的风险所涉及的风险。最后，我们提出了一个线性回归分析和讨论的结果。这些发现使结论是影响公共资金为保健PPP投资提供便利更适当的货币价值的政策导向的公共支出水平的因素。BackgroundBOT Project FinancingBased on the value of a projects physical assets and expected financial performance of cash flows, BOT investments require a highly leveraged capital structure to provide an attractive internal rate of return to equity (IRRE) while securing bankability. Even though the capital structure varies, equity financing typically covers from 10 to 30% of the total project costs, while debt financing is obtained for the remaining 70 to 90% (Finnerty 2007).背景BOT项目融资基于项目的实物资产价值和现金流预期的财务业绩，BOT投资需要高杠杆的资本结构股权提供一个有吸引力的回报率，同时确保内部（不）可融资性。尽管资本结构的不同，股权融资通常涵盖了从10到30%的项目总成本，而债务融资得到了剩下的70到90%（那2007）。Financial institutions usually provide the debt portion of funds under the terms of nonrecourse or limited-recourse financing, which means that lenders have no recourse for repayment of their loans against the shareholders but only through the SPV segregated cash flows and assets (Zhang 2005a). To reach a desirable IRRE, project shareholders seek to maximize the debt leverage as much as the projects cash flows can tolerate, while lending institutions and granting authorities tend to require large equity commitment in the SPV to reduce the risk of a heavy debt service burden (Walker and Smith 1995) and to suggest the sponsors long-term high level of financial commitment to the project (Tiong and Alum 1997).金融机构通常提供资金的债务追索权或有限追索权的融资部分的条款，这意味着银行没有追索权，对股东贷款还款只能通过SPV隔离的现金流和资产（张2005）。为了达到理想的增强，项目股东寻求最大限度地提高债务杠杆项目的现金流可以容忍的多，而贷款机构发放部门往往需要在SPV大股权承诺减少沉重的债务负担的风险（Walker Smith 1995），表明赞助商的长期高水平的财务承诺项目（Tiong和明矾1997）。The appropriate balance between equity and debt is optimized within the limits of an acceptable debt service coverage ratio (DSCR) for both investors and debt lenders (Bakatjan et al. 2003). DSCR reflects the project debt carrying capacity, and thus it is the lenders main criterion for the financial viability of a project. DSCR is referred to as the amount of cash flow available to reimburse interest and principal payments on debt, and it is computed as the operating cash flow over the debt service in any payment period. In practice, the minimum DSCR must be equal to one to meet the debt capacity, but lending agencies usually ask for a higher value according to the anticipated risk profile of the project. So that, in general, the greater the risk shouldered by the private party, the higher the level of private equity.股票和债券之间的适当平衡是在一个可接受的偿债比率（DSCR）限制优化为投资者和债权银行（bakatjan等人。2003）。DSCR反映项目债务承受能力，因此是贷款人的主要标准，对于一个项目的财务可行性。DSCR被称为可偿还债务支付的利息和本金的现金流量，并计算经营现金流量在任何付款期限还本付息。在实践中，最小的DSCR必须等于一个满足债务的能力，但是贷款机构通常会要求更高的价值根据预期风险的项目。所以，总的来说，更大的风险承担的私人聚会，私人股本的水平越高。The apportion of public governmental-granted equity to the capital structure not only reduces the total amount of private finance required but also allows for a higher debt leverage. In fact, the reduced demanded private financing is associated with smaller risk borne by the private investor, who is in turn asked a lower level of equity liability by the committed debt lenders.分摊的公共政府授予股权资本结构不仅降低了总金额的私人融资需要也允许更高的债务杠杆。事实上，这种减少的要求私人融资与私人投资者所承担的风险较小有关，而私人投资者则要求较低的股权承担债务的债务。As stated above, the appropriate amount of money invested by the government should cover the non-self-financing part of the investment costs, but it often happens that the level of public funding is sized over this limit. The justification of this notion is that the level of public financing serves as coverage of the project risk profile. For this reason, an empirical model based on the identification of the most important risks and associated indicators is developed in order to study the extent to which risks might affect the level of public financing in BOT health-care facility projects.如上所述，政府投资的适量的资金应该包括投资成本的非自筹资金，但通常情况下，公共资金的水平超过这个限度。这一概念的理由是，公共融资服务的覆盖面，作为项目的风险分布。因此，实证模型的基础上，最重要的风险的识别和相关的指标是为了研究在何种程度上风险会影响BOT保健设施项目筹资水平。State-of-the-Art Hospital BOT Projects in ItalyIn Italy, the change in health-care service provision (e.g., shorter hospital stays, organizational change from specialties to levels of intensity of treatment), the obsolescence of health-care public infrastructures, and, overall, the limits imposed on public spending and shortage of public financing to carry out necessary investments, have called for the recourse to private finance to build new hospitals or to upgrade existing ones without an ex-ante evaluation demonstrating that this scheme would be more advantageous than traditional public financing (Barretta and Ruggiero 2008; Amatucci and Lecci 2006).在意大利艺术院BOT项目状态在意大利，医疗服务供给的变化（例如，住院时间短，从专业的治疗强度水平的组织变革），废弃医疗公共设施，总的来说，限制公共融资的公共支出和不足进行必要的投资，呼吁求助于民间金融建立新的医院或升级现有的没有事前的评估表明，该方案将比传统的公共融资更有利（巴瑞塔和鲁杰罗2008；amatucci和lecci 2006）。As of May 2009, based on consultation of the database published by the Italian national observatory of PPP (pieffe.it), public health-care authorities have put out to bid 42 hospitals and 29 support facilities, such as parking lots, hotels, and production of utilities since 1999. Out of the total 71 initiatives, 47 contracts were awarded to a concessionaire, with an investment totaling 3 billion euro. Among those, only 28 are reported to be awarded hospital facilities, which are today partly into the design phase, under construction, or in operations.截至5月2009，基于数据库的PPP的意大利国家天文台出版咨询（http：/ / pieffe。它），公共卫生当局提出了出价42的医院和29的配套设施，如停车场，酒店，因为1999的水电生产。从总的71项举措，47合同授予特许经营者，一个投资总额达30亿欧元。其中，只有28被报告被授予医院设施，这是今天部分进入设计阶段，在建设中，或在操作。The majority of hospital BOT arrangements provide for the concessionaire to maintain the infrastructure and operate auxiliary activities and commercial services, while the public agency manages and operates the core clinical service with their resources. Operations and maintenance (O&M) services typically apply to equipment, built assets, and utilities; auxiliary services are related to catering, laundry, cleaning, waste management, security, and Information Technology (IT) hardware systems; commercial services might involve shops, parking lots, guest rooms, and childrens day care. Only a few contracts require private O&M of health-care equipment, IT software tools, medical gas systems, emergency and operation rooms, diagnosis, and other paramedical services (Finlombarda 2010). To benefit from O&M and, if applicable, paramedical services, the public agency typically pays the SPV an agreed-upon-the-contract service fee. On the contrary, the concessionaire collects fees from tenants and end users for commercial services.大多数医院BOT安排提供特许来维护基础设施和操作辅助活动和商业服务，而公共机构管理和经营自己的核心资源的临床服务。运营和维护（或）服务通常适用于设备，建立资产和公用事业；辅助服务与餐饮，洗衣，清洁，废物管理，安全和信息技术（它）硬件系统；商业服务可能涉及商店，停车场，客房和儿童节的照顾。只有少数合同要求私人奥美医疗保健设备、软件工具、医用气体系统、急救和操作室、诊断、和其他辅助服务（finlombarda 2010）。从运维效益，如果适用，医疗服务，公共机构一般是SPV商定的合同服务费。相反，特许人从租户和商业服务的最终用户收费。As a consequence of the limited number and scope of contracted auxiliary and nonclinical services, most projects are reported not to have self-financing ability, so that public funds are necessary to cover the non-self-financing portion of the initial investment. As of 2007, public sources of funds are on average 57% of the investment; hence, private financing captures the remaining 43%, which can in turn be decomposed into debt (38%) and equity (5%) capital, so that the debt-to-equity ratio equals about 88%=12% (Amatucci et al. 2007). As of May 2009, public financing ranges from 0 to 81% of the total investment, with the decreased median value equaling approximately 36%. Also, it is observed that large projects have a higher share of public funding and a higher award rate: This fact indicates that a high level of public financing reduces the project risk exposure with a resulting increased likelihood of the project to be successful and attractive for promoters and equity investors (Amatucci et al. 2007).由于有限的数量和范围的辅助和非临床服务，大多数项目都不会有自我融资的能力，使公共资金需要覆盖的初始投资的非自融资部。为2007，资金来源是对公共投资的平均水平57%；因此，民间融资获取剩余的43%，这反过来又可以被分解为债务（38%）和（5%）股权资本，使资产负债率大约等于88% = 12%（amatucci等人。2007）。截至5月2009，公共融资的范围从0到81%的总投资，以降低平均值相当于约36%。另外，据观察，大的项目有一个更高的公共资金和更高的奖率：事实表明，高水平的公共融资降低项目风险与所产生的增加项目成功的和有吸引力的发起人和股权投资者（amatucci等人。2007）。Research MethodologyThe research was carried out through the following steps. First, we developed a model to understand the risk factors that might influence the level of public funding in BOT projects. To this end, we identified risk sources and associated indicators, which are in turn measured by corresponding selected parameters.研究方法论通过以下步骤进行研究。首先，我们开发了一个模型，了解风险因素可能影响BOT项目的公共筹资水平。为此，我们确定了风险源和相关的指标，这是由相应的选择参数。Second, we gathered data through both consultation of public databases and direct inquiries from local health-care agencies. The data set records information on public funding and the identified risk parameters of the BOT hospital projects awarded in Italy from 1999 to May 2009. All initiatives total approximately 2.6 billion Euro, and the average size of projects is about 110 million euro each.其次，我们收集了数据，通过公共数据库的咨询和当地卫生保健机构的直接查询。数据集上的公共资金和风险参数的BOT项目授予意大利医院从1999到2009的记录信息。所有举措合计约26亿欧元，平均规模约为1亿1000万欧元。Then, we conducted an exploratory data analysis and investigated the multicollinearity among the risk parameters. 然后，我们进行了一项探索性数据分析，研究了风险参数之间的多重共线性。Finally, after assuming that the level of public financing is the response variable and the risk parameters are the independent variables, we completed a linear regression analysis to understand the relationship between the project risk profile and the capital structure. In particular, the linear regression analysis, performed using the Minitab software tool, tested whether the independent variables considered are relevant factors and whether they have a positive or negative impact on the proportion of public funding to the total investment. Linear regression proves to be a valuable an