Management of medical devices and implants fixed amounts, the efficiency of a well conducted public procurement based on simulated models.

Details

Supervisors

Piessevaux, Hubert ; Lambaux, Bénédicte

Faculty

Faculté de pharmacie et des sciences biomédicales

Degree label

Master de spécialisation en pharmacie hospitalière

Abstract

Introduction. Since late 2020, medical technology companies have faced shortages, increased costs, and unpredictable delivery times due to component and raw material shortages, Covid-19 pandemic, and the energy crisis. European public healthcare institutions have been affected too. Hospital supplies especially medical devices (MD) and implants, have seen price increases of 10 to 20%, with some items rising up to 45%. The new Medical Devices Regulation adds some additional challenges. The current fixed amounts allocated by the Institut National d’Assurance Maladie-Invalidité (INAMI), Belgium’s healthcare insurance, are often insufficient to cover medical interventions, causing budget gaps. Hospital pharmacists play a key role in purchase and distribution of the MD and implants, ensuring a reliable supply and promoting standardization. Objectives. This study aims to assess the impact of hospital pharmacists in managing medical devices and implants, considering the fixed amounts allocated by INAMI. It seeks to evaluate the situation in our gastrointestinal endoscopy (GIE) unit and to determine if a well-conducted procurement process can effectively balance costs with the fixed amounts. The question of whether the fixed amounts should be indexed is also explored. Methods. The working group conducted a well-designed public procurement and focused on fixed amounts in a GIE unit. After a retrospective analysis using the Zorgi-InfoHos SolutionsⓇ 2022 consumption data to assess the financial context of the GIE unit at Cliniques universitaires Saint-Luc (CUSL), the second phase involves simulated models developed with RⓇ. The model processes multiple databases to predict the impact of a well-conducted public procurement on MD and implant costs balance using four assumptions. The different models focus on predicted cost reductions per batch based on market variability and working group experience but also of fixed amounts inflation indexing. Results. The procurement process, initiated in September 2022, compiled a list of 54 MD and implant batches based on the unit's needs. A prospection phase was conducted, and 14 firms responded to a questionnaire. Award criteria were established for evaluating bids, including price, quality, and services. The public procurement value for 4 years was estimated at 6.767.656,48€. The analysis of fixed amounts showed a yearly compensation of around 1.400.000€, but an unfavorable cost-benefit balance for medical procedures, resulting in an average loss of 200€ per procedure in 2022. Some procedures, like upper gastrointestinal (GI) echoendoscopy and endoscopic retrograde cholangiopancreatography (ERCP), had significantly negative balances. An experimental procurement analysis did not turn any deficit-prone procedures profitable, though some gains were observed through price negotiation. Certain fixed amounts would require revision by INAMI to achieve financial equilibrium. Discussion. This study highlights the significance of public procurement in the healthcare system, particularly for acquiring medical devices and implants. Reducing costs is crucial for hospitals to manage budgets effectively and deliver proper patient care. Although the benefits of various procurement scenarios may be modest, a well-conducted public procurement process offers several advantages, including negotiations on favorable terms, cost savings, transparency, and encouraging innovation in the medical device market. Standardizing device usage and revising fixed amounts are also essential for optimizing budgets. Effectively managing the cost-benefit balance brings multiple advantages, such as improved patient care, financial sustainability, and enhanced reputation for healthcare units. However, limitations in data availability and focus on one specific unit warrant further study for broader insights. Conclusion. Addressing the management of hospital fixed amounts and financial deficits in medical interventions is crucial for Belgium's healthcare system. Though public procurement's impact may be modest, it offers long-term contractual advantages and cost savings. Proactive INAMI involvement in revising fixed amounts is essential for sustaining the healthcare system's quality and stability. By adopting comprehensive measures, Belgium can strengthen its healthcare system effectively.