The study presents: •seven country studies at macro level describing the PPP/PFI trends/experience of individual Member States of which a minimum of one from EU -12 in the health sector, highlighting the benefits and the challenges of integrating a PPP programme into national health planning and into budget and public financial management procedures, trends in project numbers and value, financial structures, contractual arrangements and the planned and ex post fiscal impact; •case studies of fourteen individual PPP/PFI projects in the health sector, including hospitals with and without clinical services and other health facilities and services; •an analysis of the overall trends in PPP/PFI procurement in the health sector across the EU since 1990, identifying the current challenges, especially in the context of the debt crisis in some of the countries. Study was implemented by the Epos Health Management, Ecorys and Erasmus University -Rotterdam.