This study assesses the performance of centralised procurement of medicines (CPM) in Portugal from a public health perspective and develops policy recommendations. The OECD “Methodology for Assessing Procurement Systems” (MAPS) was applied in an adapted manner. Information was retrieved from the literature and procurement documents, including bids of selected procurement procedures, and from 42 interviews, thereof 37 on-site interviews with representatives of public authorities, hospitals and regional health administrations, patients and the pharmaceutical industry. Input of procurement experts of five European countries, of Portuguese participants in a stakeholder workshop and of academics in a Delphi survey have contributed to quality-assurance, participation and acceptance.
The Shared Services of the Ministry of Health (SPMS) is responsible for performing centralised procurement processes, which comprise both open procedures (Aquisições centralizadas / AC) with one (or two) suppliers and the two-stage processes of framework agreements (Acordos Quadros / AQ). Legal implementation of CPM is compliant with European standards, and the Portuguese system was found to have several strengths. These include its contribution to lower prices (compared to individual purchases) in several (but not all) cases and thus to savings for the public sector, to improved transparency of processes and governance, to more equity in access to medicines across Portugal and to a lower workload for individual procurers. However, weaknesses were also identified. There is a lack of strategy related to CPM and a lack of clarity related to the roles and responsibilities of SPMS and further relevant public institutions and stakeholders with regard to their CPM activities. The lengthy and bureaucratic processes in centralised purchases and delays in the conclusion of procedures result in non-availability of centrally procured medicines at the beginning of a year, as scheduled, and possible launch of direct procurements by hospitals (parallel procedures). Performance indicators are lacking. SPMS communication is perceived as insufficient and there is a low level of involvement of clinical expertise in CPM processes. In addition, there is an outdated list of active substances for central purchasing (last updated in 2016), no institutional coordination between the key public institutions ACSS, INFARMED and SPMS and limited knowledge of the market by SPMS.
All addressed stakeholders were, in principle, positive towards the idea of CPM in Portugal. It is advised to maintain and extend the strengths of the current CPM system while addressing identified weaknesses. The overarching recommendation is to develop an updated procurement strategy to ensure clarity of objectives, roles and responsibilities and procurement tools. Management recommendations urge strengthening the following areas: the measurement of performance, capacity, collaboration among public authorities and with users, stakeholder management, the service character of SPMS and procedures to prepare and conduct procurements.