The procurement procedure for medicine purchases? For university hospitals, it is rather an exception. Medicaments were often purchased directly and without competition
Press release to audit No. 17/19 – 3. 9. 2018
The Supreme Audit Office reviewed the management of three selected hospitals for the period of 2014-2016, namely the University Hospital Brno (UHB), the Faculty Hospital in Motol (FHM), and the Central Military Hospital - Military University Hospital in Prague (CMH). Auditors examined, for example, how these hospitals had purchased medicines and medical devices, and compared the prices, for which the hospitals had purchased these products, on a sample of 35 types of medicaments and 20 types of medical supplies. They also focused on how the Ministry of Health (MoH) and the Ministry of Defence had fulfilled the role of the founders of these hospitals. It emerged that these hospitals had purchased very often medicines and medical supplies without a tender procedure, often on the basis of direct orders. The comparison of prices then showed that hospitals had been buying identical medicaments and medical devices at substantially different prices, even from the same suppliers.
The scrutinized hospitals tended to acquire medicaments by means of a tender procedure at minimum, although they were obliged to use the procedure as contracting authorities. In the case of a sample of, as it is called, centralized medicaments, the CMH used the procurement procedure for 24% of these medicaments, the FHM used it approximately for 19%, and the UHB did not even buy any of the medicine in this way. In the sample of anti-infectious medicine, the CMH used the procurement procedure for 29% of purchased medicaments, UHB for 15%, and FHM in only 5% of the cases. Similar results were also detected in the case of medical supplies, which, for example, the UHB had purchased completely without a tender procedure. In total, the CMH used procurement procedures the most. The UHB did not almost use it at all.
"We understand that there are cases where it is not feasible to acquire these things through a tender procedure. But we are witnessing a situation where this way of buying medicine is an exception rather than a normal practice and that cannot be explained by anything acceptable, "said the SAO President Miloslav Kala.
Auditors also compared the prices for which the respective hospitals had purchased identical medicaments in the same period of time and, in some cases, revealed significant price differences for the same goods. For example, the CMH purchased MEROPENEM KABI medicine for CZK 956 per pack and the FNB bought it for CZK 3,300 per pack. The FHM purchased PIPERACILLIN/TAZOBACTAM KABI for CZK 385 per pack and the same medicament was initially acquired by the UHB for CZK 2,103. This was a purchase from the same supplier. Such differences show that there is a scope for cost savings in hospital management.
The purchase of medicines and medical supplies also involves the payment of bonuses to hospitals from the contractors. The acceptance and managing of bonuses in the years under review was non-transparent, non-systemic, and without clear rules. For example, the SAO found out that the UHB and the FHM had not concluded all bonus contracts in a written form - in some cases, these had been only oral agreements. The faculty hospitals did not publish the concluded contracts for bonuses with reference to business secrets in the register of contracts. Due to the absence of clear hospital rules, they also approached to bonuses in procurement procedures differently. In the tender procedures, the FHM did not take into account the bonuses as a criterion for the final price. On the contrary, the CMH is an example of good practice in the procurement procedures, of which the criterion was not only the bid price but also the bonus.
After submitting the audit report, the Ministry of Health adopted a corrective measure for their hospitals in which it specified, for example, the conditions for accepting bonuses, how to manage them, and other parameters. The actual effectiveness of this measure will only be verified in a follow-up audit. This is not yet a system solution that would affect all hospitals.
In the audited years, the value of total bonuses for pharmaceuticals and medical devices at reviewed hospitals amounted to around CZK 1 billion.
Supreme Audit Office