Italy, as many other countries, adopted the design–build–finance–maintain (DBFMO) Anglo-Saxon model to build new hospitals. This model proved to be rigid, nontransparent, nonvalue for money, and unaffordable. The aim of this article is to analyze the main drawbacks of the traditional DBFMO public–private partnerships (PPP) contract applied to the health care sector, by referring to the Italian experience, and to discuss the evolutions, conceived through an inductive/deductive approach, conducted in a context of deep collaboration between academia, health care authorities, and market players to make PPP contracts more value for money, flexible, and affordable. The article provides also an example of the role of academia in closing the rigor–practice gap by supporting and facilitating an institutional change.
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