SAO audited management of four university hospitals

Press Release – July 29, 2013

The Supreme Audit Office (SAO) audited management of the General University Hospital in Prague, and university hospitals in Vinohrady – Prague 2, Olomouc, and in Hradec Králové within the years 2010 and 2011. The audit report reads that all four audited university hospitals kept balanced accounts with a slight surplus and three hospitals were decreasing the loss from previous accounting periods.

The SAO scrutinized costs of medications and health-care materials, which for example got to 41.9 % of the overall annual expenses of one hospital. Auditors focused on prices of medications purchased by individual audited hospitals. During the audited period, the hospitals spent the total amount of CZK 8,500 million for medications. At the same time, the hospitals used tenders and electronic auctions only on rare occasions when purchasing medications.

Audited university hospitals concluded written agreements concerning medications purchases with only small number of suppliers. One hospital purchased medications from more than 230 suppliers but had framework agreements with only three of them. Other medications were purchased on the basis of e-mail, fax, and phone orders. In 2010 and 2011, two audited hospitals purchased medications for CZK 280 million without written agreements. That is why auditors could not verify whether the purchase prices were in accordance with agreed costs.

By analysing invoices, auditors compared costs of the antibiotic Augmentin, the heparin Clexane and several other medications, which are used at specialized health care facilities. With the antibiotic, eight variants were verified. Prices of seven out of the eight variants fluctuated. The biggest package price difference made CZK 359.8 – the price for a package was from CZK 220 to CZK 580. With the heparin medication, four variants were verified and with three variants, the prices differed. The biggest package price difference made CZK 2,177 when the price of one package fluctuated from CZK 2,732 to CZK 4,909.

During the audited period, audited hospitals paid over CZK 5,000 million for medications, which are used at specialized health care facilities. Out of these medications, auditors compared 63 identical medications and their price differences. The biggest package price difference made CZK 33,264 – the package price of the same medication was fluctuating from CZK 95,841 to CZK 129,105. One medication was supplied to various hospitals for different prices, with a package price varying by CZK 10,527 (62.6 %).

With health-care materials, auditors focused on costs of artificial pacemakers and implantable cardioverter-defibrillators, which were purchased by the audited university hospitals for the total amount of CZK 1,000 million in the period 2010–2011. Two audited hospitals purchased pacemakers and cardioverter-defibrillators for CZK 342 million without written agreements. The price of the same pacemaker, which was purchased from one supplier, differed at individual hospitals from CZK 84,755 to CZK 168,160. One peacemaker’s price fluctuated by CZK 83,405. With one supplier, costs of purchased cardioverter-defibrillators varied by CZK 520,000. The same cardioverter-defibrillator cost from CZK 630,000 to CZK 1.15 million.

Auditors also scrutinized costs of electric power, water rates, security, cleaning, and other services. When compared to 2009, the expenses decreased slightly in 2011, in spite some costs per unit increased in some cases. Auditors also checked up the wages and revenues from the regulation fees.

For further details about auditing operation No. 12/23 (in Czech only), see the following link: (pdf 501 kB).

Communication Department
Supreme Audit Office

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