In the past several decades, the number of medical devices and companies manufacturing them has grown substantially. Medical devices range from simple tongue depressors to high tech medical imaging devices. Today, medical device sales in Canada total approximately 6 billion per year and involve about 1,500 companies with over 35,000 employees.
With such a wide range of medical devices and with innovation proceeding at such a rapid pace, physicians, hospitals and government health departments are faced with an array of increasingly complex issues when making procurement decisions.
Who is responsible for purchases ?
The procurement of medical technologies raises a number of important issues and questions:
The selection of medical devices and suppliers: Do companies influence decision makers and their purchase decisions? And what about their influence on physicians? How can we ensure there is transparency and that practices are ethical?
The role of health technology assessment (HTA): How can HTA be effectively used in the evaluation of not only costs and efficiency, but also social, legal and ethical aspects?
The life span and management of medical technologies: How can these be taken into account before purchases are made?
The matching of new technologies to human resources: Are healthcare professionals adequately trained to use new technologies?
The quality and safety of medical technologies: How can these be combined with cost considerations?
In an attempt to resolve some of these issues, a number of countries have established group purchasing organizations (GPOs) in the healthcare sector that are similar to those in industry. As a result, decision-makers and physicians are now not the only ones involved in the purchasing of healthcare supplies. What is the role of the healthcare GPO? One definition states that it “assists in promoting quality healthcare relief and assists diverse providers in effectively managing expenses. Strategic partnerships with healthcare providers create new revenue streams and also reduce expenses, allowing for improved operating margins for the healthcare providers, while members enjoy value added benefits like clinical support, supply chain support and comprehensive portfolios of products and services to address specific needs” (Wikipedia ). However, GPOs are also concerned with ethical issues around such aspects as lobbying, safety and quality (Bednar 2008).
Is cost the only concern ?
Today, cost is not the only concern when purchasing medical devices. In fact, innovation has become a major issue because procurement and innovation are intricately connected. In the UK, recent experience with a digital hearing aid shows that public procurement factors influence the selection, adoption and diffusion of new technologies. In a nutshell, the experience showed that when producers, users and buyers of technologies all work together, an innovation can be adopted quickly and efficiently while the needs of all parties can be met (Phillips et al. 2007).
Moreover, social and political factors may compete with cost considerations; for example, a technology may be adopted because of lobbying pressure. A patient association may advocate for the purchase of a costly technology like LVAD (left ventricular assist device) or MRI (magnetic resonance imaging). Political factors may also influence purchase decisions for some technologies; this is the case for some vaccines. The Quebec government recently implemented a HPV (human papilloma virus) vaccination program, which some support while others criticize as not appropriate at this time (see April 2008  in our archives).
This month, we will learn more about procurement issues. How does the Quebec government purchase medical technologies? We will learn about hospital planning at a large teaching hospital in Montreal (Centre hospitalier de l’Université de Montréal, or CHUM), and about procurement at the Montreal Heart Institute and at a European teaching hospital, the Centre hospitalier universitaire Vaudois in Lausanne, Switzerland. Finally we will present the point of view of the medical industry, as represented by MEDEC.
|Author :||Stéphanie Tailliez, Ph.D.|
Phillips W, Knight L, Caldwell N, Warrington J (2007). Policy through procurement – The introduction of digital signal process (DSP) hearing aids into English NHS. Health Policy 80: 77-85.
WHO (2003). Regulatory Challenges. WHO Drug Information vol.17(4).
Bednar, R.J (2008). Some GPOs Take the Lead to Avoid a Healthcare Supply Chain “Perfect Storm”. Medical Devices Law & Industry, vol.2(4).