2012-03-05
Different level of medicine supply in hospitals speaks of different quality of treatment
The National Audit Office has performed an audit of medicine supply in hospitals. Auditor General Giedrė Švedienė commented on the audit report as follows: “We have established that the share of funds allocated for medicines by hospitals differs 6.5 times in large hospitals, 4 times in regional and district hospitals, and more than 10 times in hospitals of palliative treatment and care.”
The share of funds to be allocated for medicines is established by the founder of the hospital, which, however, may transfer this function to the hospital itself. “The dilemma faced by hospital administrators, namely, whether more funds should be allocated for more effective medicines or reconstruction of the hospital building, is often resolved to the disadvantage of the medicine acquisition,” noted the Auditor General.
Public auditors also checked whether treatment schemes are in place and used in hospitals and whether lists of medicines used for treatment have been drawn up. The application of these criteria for the assessment of the efficiency of medicine use in hospitals is recommended by the World Health Organisation.
The number of treatment schemes used in hospitals was found to be highly different. Some large hospitals follow 84 treatment schemes meanwhile others – only 7. At the time of the audit no such schemes whatsoever were in place in two out of nine regional hospitals. No treatment schemes were available in one third of district hospitals (i.e. 8 out of 24) and almost three quarters of care hospitals (13 out of 16) which provided the data. Besides, a review of all treatment schemes in place showed that they have been developed only for less than half of most treated diseases. In the absence of treatment schemes, the quality of treatment services provided in different hospitals of the same level may be assumed to be different.
The audit established that some hospitals neither purchase medicines included in treatment schemes and pharmaceuticals with higher therapeutic value nor receive these by way of support. This fact also indicates potential failure to ensure adequate quality of treatment, or that necessary medicines have to be bought by patients themselves.
Having analysed the duration of medicine acquisition by way of public procurement, the auditors established that such procedures in hospitals last more than 100 days, i.e. ten times longer than through the Central Project Management Agency. In addition, a comparison of the prices of medicines purchased through a public procurement process demonstrated that these prices in hospitals differ several times. Also, hospitals do not practice joint purchase of medicines in cooperation with each other. Foreign experience has shown that joint purchases reduce medicine costs by up to 20 % and help to use human resources of health institutions in a more efficient way.
Certain deficiencies were also established in centralized provision of hospitals with medicines purchased through the National Health Insurance Fund.
The National Audit Office recommended to the Ministry of Health to coordinate application of treatment schemes in hospitals, to set and to ensure adherence to criteria for the drawing up of medicine lists in hospitals, as well as to provide for and implement measures facilitating supply of medicines to hospitals at the best price.
The National Health Insurance Fund was recommended to perform regular analyses of purchase and use of centrally purchased medicines and to improve the process of the supply of these medicines to hospitals.
Public audit summary:
Supply of Medicines in Hospitals