Purpose - The purpose of this paper is to detect how Value for Money (VfM) in Italian Project Finance (PF) investments can be enhanced and challenging criticalities minimized, with a synergistic interaction of macroeconomic, legal and institutional actions. Design/methodology/approach - Analysis of VfM quantitative key drivers, within a public-private partnership (PPP) framework with specific reference to a recession context, with infrastructural capital rationing implications. Empirical evidence is given by an Italian PF healthcare model, testing the impact of legal and macroeconomic changes. Findings - Deleverage, ignited by W-shaped recession, disinflates PPP investments, so forcing to innovative and penniless solutions. Unreliable and short-sighted legislation and consequent unfriendly business climate may frighten investors, so decreasing competition and VfM. Research limitations/implications - VfM sensitivity to macroeconomic and legal/institutional parameters is too wide and capriciously erratic to be comprehensively modeled. Tips for further research include pro-growth tax and budgetary policies, risk minimization issues and other synergistic targets. Practical implications - Guidance to regulators to fine tune legal and institutional tools, so as to create a stable, business friendly environment. Recessions may be softened by sensitive policymaking, or exacerbated by short-sighted ignorance and lack of strategic focus. Originality/value - Unprecedented analysis of legal and macroeconomic changes on VfM in Italian PF investments, with original tips for VfM optimization, in a comprehensive PPP framework.