In Dutch healthcare a shift in discourse is taking place where the focus is moving from ‘disease and care’ to ‘health and behaviour’. If this change in language (thinking) is combined with changes in structure (organisation) and daily practices (doing) in healthcare it constitutes a societal transition. Using a discourse analysis combined with a transition perspective, we analyse this shift through the development and diffusion of the concept of Positive Health, which has developed from niche discourse to an important part of the national health policy. This article reflects on this successful integration in government policy and the applied (discursive) strategies to achieve legitimacy for Positive Health. Additionally, the question is posed if discursive change (strategies) can serve as a motor for transformative change.

The core argument to develop public projects and deliver public services through PPPs is that PPPs are cost-effective and would deliver added value over traditional public procurement. Little is known, however, about the extent to which PPPs are indeed cost-effective and deliver added value. This article uses empirical examples to demonstrate and discuss three evaluation strategies to assess the performance of PPPs. The first strategy involves the ex-ante comparison of PPP performance with benchmark data – based on business cases, the public sector comparator, and the public-private comparator – for traditionally public procured projects. The second strategy involves the ex-post comparison of PPP projects with very similar projects that have traditional contracts not including private financing. The third strategy involves the ex-durante comparative evaluation of projects’ operational costs taking a one-year cutout of those operational costs. The three strategies focus, respectively, on the planning and procurement phases, the implementation phase, and the operational phase. Advantages and disadvantages of the strategies are discussed and proposals are offered for combining the strategies and how such combined evaluation strategies can improve decision-making on the use of contract types for the delivery of public projects and services.