The North Tees and Hartlepool NHS Trust has started the search for a developer to build a new hospital in Hartlepool at Wynyard Business Park following an independent review of the outline business case.
Expressions of interest are also being invited for pension funds to lend the money to the Trust.
Trust board chairman Paul Garvin described the process as similar to taking out a mortgage.
He said: “We borrow the money, we build the building, and we pay it back year on year.
“We are acutely aware that the funding route we are pursuing – a pension fund holder solution – is unique and it is the board’s responsibility to ensure the whole project provides value for money and is sustainable over the long term.”
He added there would be another review at the end of the 18-month procurement process to give the board the final assurance it needed to borrow the money, award contracts and begin the build.
“However, we hope to have a just over three-year build, and we could open the doors of the new hospital in late 2016 or early 2017.”
The project is a smaller-scale version of the original £460m plan, which was scrapped, along with 12 others nationwide, in June 2010 as part of measures by the coalition government to save £2bn.
A PFI project could have cost £660m over the 30-year life of the scheme.