On March 30 about 150 representatives of hospitals, public sector institutions, companies and healthcare professionals met at the Health Care Conference: How much courage do we need for good quality public procurement? held under the auspices of the Ministry of Finance.
Read the press release from the conference.
Photogallery available here.
We believe the objective of the health care system is to provide the highest quality care through the efficient use of available resources. Health care providers control only two of three variables in that equation: quality and efficiency. The level of available resources is determined by political decisions outside of the system: how much to require taxpayers to contribute to the system and how much to charge private individuals for their personal care. Therefore, the primary policy question facing health care providers is how to provide higher quality while increasing efficiency.
Almost by definition, efficiency cannot be determined without first defining quality. Quality measures what the system does; efficiency measures how well it does it. Without a clear definition of what quality means, and a way to measure quality, the efficiency of a system can only be measured by the cost of activity.
Procurement can be a tool for achieving efficiency or cutting costs. Since the current health care system does not apply a universal definition of quality health care and most health care institutions have not developed individual measures of quality care, it is difficult for procurement officials to determine how the products and services they purchase achieve greater efficiency in the provision of quality health care. As a result, they tend to substitute price for efficiency. The lack of a clear and measurable definition of quality in health care, therefore, tends to create pressure for low cost provision of health care without regard to system performance.
This is why we argue that you cannot create quality in health care procurement until you measure the quality of health care provided. That measurement would need to be compared to other health care systems, and would need to be applicable to the daily provision of health care by hospitals, clinics and individual health care professionals.
Quality is not an assessment of the capacity of the system (number of doctors, number of beds available, number of procedures undertaken), but the result of how that capacity has been utilized. That is why we agree with the Ministry of Health's declaration that the Czech Republic should set the primary goal of its health care system to be the increase in Health Life Years. Healthy Life Years is an approximation of the major policy goal of any healthy system: the ability of people to live with the lowest possible interference from illness, injury, or treatment.
Healthy Life Years cannot be directly translated into the procurement, but its components can. Healthy Life Years can be divided into three factors: long life, number of incidents of health problems, and period of poor health. Quality criteria related to these factors for almost any procurement can be generated. For instance, a medical device can be assessed for its ability to reduce major side effects, future recurrence of the injury or illness, length of treatment and recovery to active life, and, in some cases, impact on lifespan.
Absolute Monetary Value gives health care providers a tool for assessing the efficiency (quality provide per crown spent) value for products and services purchased. It allows providers to establish the value potentially provided by the procured product or service by estimating the savings it would create (for instance, the savings of a shorter hospital stay or decreased risk of treatment for side effects), and then adjusting the bid price by that value. By implementing Absolute Monetary Value, providers will connect procurement not just with the economic performance of their entity, but with the overall health care performance not just of that entity, but the entire system.
Read the text in Czech here.