Effects of procurement practices on quality of medical device or service received: a qualitative study comparing countries
Por:
Lingg, Myriam, Wyss, Kaspar, Duran-Arenas, Luis
Publicada:
8 ago 2016
Categoría:
Health Policy
Resumen:
Background: We know little about how procurement of a high-risk medical
device (HRMD) affects clinical practice and outcomes. In health systems
in high-income countries, and specifically those that maintain a
national arthroplasty registry, procurement decisions are frequently
guided by long-term clinical results, with the goal of ensuring at least
standard quality of HRMDs. But in countries like Mexico, decision-making
is often dominated by lowest acquisition price. We set out to study the
impact of procurement for orthopaedic HRMDs on clinical procedures and
outcomes.
Methods: We based our qualitative study on 59 in-depth interviews with
stakeholders from Mexico, Switzerland, Germany, and UK: orthopaedic
specialists, government officials, other experts, and social security
system managers or administrators. We took a healthcare delivery
approach to capturing and comparing factors that affected the
regulations of HRMDs and procurement processes, and to understanding
connections between procurement and clinical practice.
Results: Our findings demonstrate for procurement processes that the
three European countries compared to Mexico don't have similar concerns
with regards to their procurement processes. Deficiencies of procurement
regulations and practices identified from representatives in Mexico were
almost absent in European countries. We identified three areas of
deficiency: 1) HRMD regulations based on insufficiently robust clinical
evidence (mainly noted by European countries); 2) Follow-up on Health
Technology Assessments is inadequate (noted by Mexico) and methodology
not always good enough (noted by European countries); and, 3)
Lowest-acquisition price often guides procurement decisions and thus may
not align with needs of clinical procedures (noted by Mexico and some
European countries).
Conclusions: Procurement processes for orthopaedic HRMDs may have an
impact on clinical procedures and outcomes. A favourable approach is one
where orthopaedic specialists are parties to the procurement process,
and post-market surveillance data informs decision-making. Actors in the
procurement process can improve their impact on clinical procedures and
outcomes by developing specific strategies that better align the needs
of both, procurement and clinical procedures.
Filiaciones:
Lingg, Myriam:
University of Basel, Petersplatz 1, Basel, Switzerland
Swiss Tropical and Public Health Institute, Swiss Centre for International Health, University of Basel, Petersplatz 1, Basel, Switzerland
Univ Basel, Peterspl 1, CH-4003 Basel, Switzerland
Univ Basel, Swiss Trop & Publ Hlth Inst, Swiss Ctr Int Hlth, Peterspl 1, CH-4003 Basel, Switzerland
Wyss, Kaspar:
University of Basel, Petersplatz 1, Basel, Switzerland
Swiss Tropical and Public Health Institute, Swiss Centre for International Health, University of Basel, Petersplatz 1, Basel, Switzerland
Univ Basel, Peterspl 1, CH-4003 Basel, Switzerland
Univ Basel, Swiss Trop & Publ Hlth Inst, Swiss Ctr Int Hlth, Peterspl 1, CH-4003 Basel, Switzerland
Duran-Arenas, Luis:
Centre for Mexican Studies in the United Kingdom, London, United Kingdom
National Autonomous University of Mexico, Medical Faculty, Circuito Interior, Ciudad Universitaria, Av. Universidad 3000, Mexico, Mexico
Ctr Mexican Studies United Kingdom, London WC2R 2LS, England
Univ Nacl Autonoma Mexico, Fac Med, Ciudad Univ,Ave Univ 3000, Mexico City 04510, DF, Mexico
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