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Procurement of Health Care services in Stockholm County Council

Procurement of Health Care services in Stockholm County Council. Part 1 Background Objectives Legal conditions Present state of the process. Background I The Swedish system. Based on taxation Since 1997: County Councils (regional taxation) responsible for health care (cure)

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Procurement of Health Care services in Stockholm County Council

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  1. Procurement of HealthCare services in Stockholm County Council Part 1 • Background • Objectives • Legal conditions • Present state of the process

  2. Background IThe Swedish system • Based on taxation • Since 1997: • County Councils (regional taxation) responsible for health care (cure) • Local authorities (local taxation) responsible for long term care (nursing homes etc.) • Purchaser – provider split in more than 50 % of County Councils • Public provision very dominant in all County Councils, except Stockholm

  3. Background IIThe role of private provision • 1997Nearly 400 external providers accounted for 17% of the care financed by Stockholm County Council. (High level, to Swedish standards.) • TodayNearly 500 external providers, 25% of the care financed by the County Council.Additionally approximately 65 units are waiting for procurement. • Mainly primary care and smaller units. But now one private acute care hospital (the company sold by the County Council, not the building)

  4. Initial political conditions • Continued co-operation between providers • Patient’s freedom of choice at least as today • Good conditions for keeping and recruiting qualified staff • Good conditions for medical development • Pluralism • Number of emergency-service hospitals unchanged • Number of university hospitals unchanged • Geographical considerations

  5. Objectives • Increased diversity, freedom of choice for patients and staff, competition and openings to new initiatives • More “power” and “reality” into the purchaser – provider interaction

  6. Legal conditions • One private and two public “corporatised” hospitals triggers the Swedish Law on Public Procurement • Temporary law against for-profit acute-care hospitals

  7. The size • Hospital services for two million people, a quarter of the Swedish population • Approximately 1 billion euros per year • A “one time” tender for five-year-contracts, with options for two years of extension

  8. Original schedule START - Present map - Model Decision Routing questions 1 Political decision Decision Needs SO plan Decision Routing questions 2 Political decision Political decision Joint evaluation Identification + needs SO Work on FF – description of service FF Referral SO + committee FF Ready Political decision Decision FF at HSN Val Tenders in Evaluation + negotiations Political decision 1/4 Agreement signed. Decision. 1/1 Start of operations

  9. Present state • Many conditions and alternatives have been examined, but the procurement model is still under work and discussion

  10. Procurement of HealthCare services in Stockholm County Council Part 2 • Challenges and Dilemmas – closing and still open questions

  11. Heavy risks • No interesting tenders; present providers needing more money to do what they already do • Dynamics in procurement will “eat” continuous dynamics; long term contracts to defend status quo • No continuity at end of contracting period • Focus on itemised production rather than on need and result • Heavy administration • Private oligopolies, taking away all real power from purchasers and patients • Parallel private payments erodes solidarity in financing

  12. What we have already seen • Wider range of providers raises wages – and costs – for demanded staff • Widened opportunities for entrepreneurial doctors, nurses and others • Competition will sometimes open doors that seemed to be totally blocked • Prioritisations are more difficult to hide in budgets • Initial distance is maturing to growing interest in cooperation • Improved focus on guidelines, production, quality and result are now necessary – but useful even in the traditional structure • Many of the “new” risks are already present

  13. An evolving picture? • Basing process on market scan; only services that someone will provide can be purchased • Purchasing responsibilities rather than production • Competition focused on quality and inventions; economy rather a framework • Large integrated objects, opening for subcontracting • Defining present state as starting point, evaluating on capability to develop • Making continuous flexibility a part of the agreement • Following choices made by patients/in referrals • A marginal for single sided purchaser initiated yearly change • Openings both for external and in-house tenders • Regulation of parallel financing

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