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Are public funds for medical equipment well managed?

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Are public funds for medical equipment well managed? was the main audit question.

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Are public funds for medical equipment well managed?

  1. 1. Are public funds for medical equipment well managed? Ljubljana, 10. 6. 2008
  2. 2. Audit goal <ul><li>Aim : evaluate area of medical equipment governance. </li></ul><ul><li>Key question/Audit goal : </li></ul><ul><li>How the responsible bodies co n duct medical equipment governance? </li></ul><ul><li>or </li></ul><ul><li>Are public funds for medical equipment well managed? </li></ul>
  3. 3. Definition and funds <ul><li>Medical equipment (ME) includes all medical devices related to healing and patient nursing in the hospitals as well as also medical devices for diagnostics and laboratory purposes. </li></ul><ul><li>In the time period from 2000 to 2006 (both included) the hospitals and Ministry of health has devoted around 144 mio € . </li></ul>
  4. 4. ME funding Taxpayers / Medical contributors Health Insurance Institute of Slovenia Additional free-will health insurance organizers Donations/other State budget Hospitals Ministry of health Medical equipment Part of public health institutions amortisation
  5. 5. Responsible bodies for ME governance <ul><li>Ministry of health is the responsible body for the ME governance system . Besides that Ministry trough development plans and in concordance with The investments into the public health institutions law, plans and directly executes public procurement into ME. </li></ul><ul><li>M E is managed directly by the hospitals. </li></ul>
  6. 6. ME Governance “process” (as seen by the auditees) Need! Selection Procurement Use
  7. 7. <ul><li>Identification and collection of needs </li></ul><ul><li>Record maintenance </li></ul><ul><li>In time detection and collection of needs </li></ul>ME Governance “process” (as seen by the Court of Audit) <ul><li>Analyse and plan </li></ul><ul><li>Priority setting </li></ul><ul><li>Short-term planning </li></ul><ul><li>Long-term planning </li></ul><ul><li>Procurement </li></ul><ul><li>Type of procurement selection </li></ul><ul><li>Preparation of tender documentation </li></ul><ul><li>Measures and criteria for selection </li></ul><ul><li>Contract </li></ul><ul><li>Use and control </li></ul><ul><li>Contract following </li></ul><ul><li>Use </li></ul><ul><li>Maintenance </li></ul><ul><li>Equipment replacement </li></ul>
  8. 8. Audit findings: Ministry of health <ul><li>Ministry does not possess adequate data about ME governance in the hospitals. There is some scattered data, but it is only partial and scattered in Ministry departments. </li></ul><ul><li>Ministry does not follow sufficiently mandatory annual hospitals reports about annual goal fulfilment. </li></ul><ul><li>Ministry has not yet prepared standards regarding material and material facilities. </li></ul>By our opinion in the course of executing of it’s duties regarding governance of ME Ministry of health acts inefficiently .
  9. 9. Audit findings: University Medical Centre Ljubljana (UMC) <ul><li>To the way how UMC manages ME has (in the past) have had greatest influence the fact, that UMC does not keep adequate records . In our view they should keep records about maintenance, exploitation and other relevant data necessary for efficient ME management. </li></ul><ul><li>UMC is currently introducing intensive and important changes , that should enable UMC to increase efficiency of ME management. </li></ul>
  10. 10. Evaluation of ME Governance : Slovenian Hospitals <ul><li>Court of audit estimates, that there is a high degree of risk, that Slovenian Hospitals does not govern their ME efficiently . </li></ul><ul><li>Hospitals does not keep adequate records that are needed for ME need assessment and purchase planning: </li></ul><ul><ul><li>8 out of 26 hospitals does not keep records about anticipated lifetime of ME and reasons for writing the equipment off, </li></ul></ul><ul><ul><li>10 out of 26 hospitals does not keep records about ME maintenance costs, </li></ul></ul><ul><ul><li>15 out of 26 hospitals does not keep records about ME exploitation. </li></ul></ul><ul><ul><li>Only 7 out of 26 hospitals has at least 5 year procurement plans ( high risk of intervention procurement ). </li></ul></ul><ul><li>Frequent execution of small value orders (36,2 percent of all purchases value and 89,9 percent of all purchases number). </li></ul>
  11. 11. Case example 1 – UMC <ul><li>Procurement of 38 operating tables, which was carried out b y UMC Ljubljana in the year 2002 </li></ul><ul><ul><li>value: 4.8 mio € </li></ul></ul><ul><ul><li>Purchase was not in the accordance with Public procurement act ZJN-1, because UMC has not selected the right procurement procedure . </li></ul></ul><ul><li>Court of Audit believes that irregularities and inefficiencies could have been timely prevented if the procurement tender would have been part of holistic process of ME governance and if procurement would have basis on a timely need assessment and ME procurement plan. </li></ul>
  12. 12. Case example 2 – Ministry <ul><li>Collective procurement of 18 operating tables for 5 hospitals, which was started by the Ministry of health in the years 2004: </li></ul><ul><ul><li>value: 1.4 mio € </li></ul></ul><ul><ul><li>Inadequate preparation of public procurement documentation and incorrect procedure execution of public procurement procedure in first three attempts, </li></ul></ul><ul><ul><li>Irregular selection of public procurement procedure in the fourth attempt. </li></ul></ul><ul><li>From the point of view of holistic ME governance cycle the phase of procurement in the part of documentation preparation was especially problematic. </li></ul><ul><li>Court of Audit opinion is that accepted ME standards would have prevented this situation from occurring. </li></ul>
  13. 13. Anticipated effects of the Audit - Recommendations <ul><li>Ministry will, together with hospitals, set programme goals with efficiency and effectiveness targets . </li></ul><ul><li>Ministry will re-evaluate the current status of ME standards preparation (equipment and facilities) and actual status of ME in the hospitals. </li></ul><ul><li>On the basis of comparison of actual current status and “new” standards the Ministry will prepare the plan of development programmes, which will take into the account programme goals of the hospitals. </li></ul>
  14. 14. Thank you for your attention! <ul><li>Audit report is on our web portal: http://www.rs-rs.si </li></ul><ul><li>Additional questions: [email_address] </li></ul>

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