Background
Pooled procurement (e.g. regional, centralised or cross-country purchasing) is a policy that has proven to contribute to more affordable access to health technologies. Some European countries established centralised procurement for medicines and/or vaccines at national level.
The aim of this study is to comparatively analyse centralised procurement systems for medicines (including vaccines) in selected countries, with a view to identifying prerequisites for successful implementation of this policy.
Methods
Six European countries were selected: Cyprus, Denmark, Estonia, Italy, Norway and Portugal. While all of them apply centralised procurement for an important share of their medicines and/or vaccines, they differ in terms of income, market size and geography.
In a first step, information on the design of the centralised procurement systems was surveyed in a literature review. As a follow-up, at least one interview with a procurement expert in each country was conducted to learn about experiences (mainly in May / June 2020; in Portugal in January / February 2020; for Estonia a written analysis was provided instead).
Results
The studied centralised procurement systems vary regarding their duration of implementation, scope and design. The Cypriot Ministry of Health has been centrally procuring all outpatient and inpatient medicines for the public sector for over 30 years, while Estonia started to conduct centralised procurements of defined medicines, in particular vaccines, in the 1990s, with international technical support in the beginning. Also in the 1990s, Denmark and Norway set up a centralised procurement agency whose use is mandatory for all public hospitals. In Portugal, centralised procurement for public hospitals and regional health units has been established and further developed over the years until it became fully operational in 2016, with mandatory use for defined medicines. For a decade, Italy’s national procurement agency has been offering technical support (e.g. an e-procurement platform) to public hospitals and local health units but it leaves parts of the operations (e.g. needs assessment) to the regional levels.
Despite the differences across the countries, some key prerequisites for effective centralised procurement were unanimously identified: They include a patient-centred procurement strategy, which should specify the objectives of centralised procurement, acknowledge the specificities of medicines (they are no normal commodities) and incorporate a life-cycle approach (e.g. different methods for on-patent monopoly medicines and off-patent medicines with competitors). The strategy requires political backing. Good governance structures are essential, and a dedicated entity (e.g. procurement agency) with a clear and strong mandate constitutes a major prerequi-site. At operational levels, attention should be paid to transparent and efficient processes, handled by qualified staff and supported by e-solutions. Market consultation and good prepara-tions, dialogue with users and suppliers as well as monitoring are important success factors.
Conclusions
The findings of the study are relevant to other health systems if they aim to move forward to implement pooled procurement mechanisms for medicines and vaccines at national or cross-national levels, e.g. in response to a health crisis.