Did unpreparedness cause big price differences?

Analysis of the price of medical devices, October 2020


The competent authorities in the Slovak Republic (SR), which are part of the crisis management, including the Administration of State Material Reserves (ASMR), were not sufficiently prepared for the pandemic situation caused by the coronavirus COVID-19. The purchases of ASMR indicate a disproportionate increase of the price of several medical devices (especially surgical drapes/masks, shoe covers, partly protective suits, gloves, goggles). Purchases of selected self-governing regions and cities indicate a disproportionate increase of the price of several medical devices (especially surgical drapes/masks and gloves).

The benchmark of the purchase prices of ASMR was formed by public administration entities, where the purchase of medical devices was expected even before the pandemic (standard health care, law of civil protection, etc.) (In benchmarking, proportionality was maintained by covering western, central and eastern Slovakia. The purchases of three hospitals, three self-governed regions and three regional cities served as the benchmark. Priority was given to processing data from publicly available sources and the possibility to request information in accordance with the Act on the SAO SR was also used.)

Disclosure of the structure and content of orders, contracts and invoices realized from public sources is inhomogeneous in the public administration of the SR, with different levels of information provision. As an example of good practice, the Banská Bystrica self-governed region was identified, which has a set system of publishing and availability of information at a high quality level and even the extraordinary situation did not shake it. On the other hand, the capital of Bratislava published information on only less than 1% (i.e. 5 242 EUR) of purchases from the total amount of 735 000 EUR used for the pandemic-related purchases of medical devices.

At the same time, the analysis revealed several fundamental discrepancies at the level of horizontal and vertical management of public administration. The most important of them complete the comprehensive picture of the protection of health of the population in 2020.

  • Functionalities of an efficient, transparent and economical 3D system: availability in the system, disponibility in reserves, and distribution in crisis indicate gaps and inadequacies.
  • Inconsistency of information from the website of ASMR and Government Resolution No. 96/2020.
  • Government Resolution No. 96/2020 defined individual medical devices in a very general description without further specification.
  • The material "Proposal for the creation of emergency reserves" for individual biennials until 2014 also contained the "Overview of the most important threats in terms of the analysis of territory of the SR". There is also a risk of "epidemics and pandemics" in these categories. Since 2015, the threat overview is no longer part of the proposals for the creation of emergency reserves.
  • The materials "Proposal for the creation of emergency reserves for individual biennials" since 2008 do not have a uniform processing structure.
  • From 2008 to 2020, despite the defined threats to the epidemiological development of pandemiological diseases in the world, the need of creation of crisis management body of the SR to supplement emergency reserves with selected medical devices was not identified.
  • In accordance with the Civil Protection Act, medical materials were not continuously updated by individual competent authorities.

In connection with analytical findings, the SAO SR recommends:

  • Update and unify the structure of the material "Proposal for the creation of emergency reserves".
  • Centrally at the state level to coordinate the database of medical devices within individual subjects of crisis management.
  • Check the functionalities of an efficient, transparent and economical 3D system cyclically over time.
  • Verify why the reserves of medical devices at individual levels of the state were not sufficient in the intentions of Act No. 42/1994 Coll. on the civil protection of the population and within the scope of the set tasks, management and organization of the civil protection
  • Unify and clarify the published information (contracts / orders / invoices) concerning purchases of medical devices from public sources within the public administration, including the resilience of the system during extraordinary events.
  • Check the purchases of medical devices in selected self-governed regions and cities in times of emergency.
  • Be inspired by the system of Slovak hospitals, which use the institute of ex-ante assessment of the Office for Public Procurement when purchasing (before announcing a public procurement). At the same time, the conditions of the competition, as well as the expected maximum value of the contract (using the benchmark against the prices of past purchases as well as purchases in other countries) are checked at the Ministry of Health of the SR for medicines, medical devices and special medical materials.

The full text of the analysis about this issue in Slovak language is available here.