In the “Healthcare” section there are seven such facilities: two children’s clinics in Yekaterinburg, on Shirokaya Rechka and Uktus, a new building of the Ural Institute of Traumatology and Orthopedics, a multi-storey operating block for the regional clinical hospital No. . 1, reconstruction of the clinical diagnostic center “Maternal and Child Health” and the sanatorium “Lake Chusovskoye”, the second stage of the Territorial Center for Disaster Medicine.
According to the Deputy Minister of Health of the Sverdlovsk region, Andrei Shastin, in total we would like to build 15 facilities under a concession regime, but for now we have decided on the seven most in demand. Thus, in OKB No. 1, for 60 years, the number of surgical interventions has increased by 10, the maternal and child health center, which welcomes pregnant women at risk from the entire region, is located in a former kindergarten , Chaklin Orthopedic. The institute is located in a building built in 1936, which does not meet modern requirements. The cost of facilities offered under concession varies: from 1 billion to 1.5 billion rubles for a clinic with an area of 3,000 to 6,000 square meters to 7 billion for an operating block of 13,000 square meters with full high-tech equipment. equipment.
The region already has experience building municipal energy facilities and even schools using this model, but healthcare is a special area. Hospitals are financed from the compulsory health insurance fund and the tariff structure does not imply profit, so the concessionaire will not be able to recover costs in this way. Additionally, many medical services are licensed and cannot be transferred to the developer for maintenance. In fact, the only source of return on investment is the payment of the grantor (city, region or Federation) and the maintenance of the public infrastructure of the medical institution.
According to Anton Shastin, for three years the Ministry of Health has negotiated with a dozen investors, but everything depends on the financial model. Will anyone take a chance in 2024 with a key rate of 16 percent and no guarantee that the federal budget will allocate an infrastructure loan for utility networks, as was the case for schools? The price difference is notable: up to 40 percent.
However, not everything is decided by the price, as Alexander Kopylov, deputy general director of the Atomstroykompleks corporation, is sure.
“Having completed the investment phase for two school concessions, we see that this mechanism is much more effective than 44-FZ, in any case it is faster and not more expensive,” he noted. – The construction itself takes on average 16-18 months, plus the development of design and estimating documentation, approval, passing the state exam and connecting to networks; In total, the clinic will need between 1.5 and 2 years and the operational complex three. The value of the key rate has been important in the last six months, so there is no need to wait for it to go down, but rather work and structure the transactions now.
A representative of the developer proposed conducting a comparative analysis: how much did it cost the budget to build a school under concession and within the framework of a regional state program in the same period? Analytics, in his opinion, will be the best argument in favor of the PPP. It is also necessary to convey to federal authorities the idea that granting in medicine will be faster if supported by infrastructure loans.
– The financial model is not only influenced by banking rates or subsidies, but also by fiscal instruments. Thanks to the same VAT refund, the project can “take off,” says Marina Sukhanovskaya, head of the PPP and infrastructure development commission of the Sverdlovsk Regional Union of Industrialists and Entrepreneurs. – We recommend that you contact us for expert opinions, we have established work with deputies of the State Duma.
Direct speech
Sergey Sosnovskikh, Deputy Minister of Investment and Development of the Sverdlovsk Region:
– Another promising area for the PPP is the construction and reconstruction of sports infrastructure, including the December 2023 presidential order on expanding the sports capabilities of educational organizations and the use of their land for this. Based on feedback from other regions, it is possible to build a financial model that will be of interest to an investor or operator in terms of profitability. In addition, the federal project “Business Sprint” provides subsidies for this.
