Brief Communication

Análisis de tiempos y movimientos en el proceso de  contratación administrativa de medicamentos, en el Hospital México durante el año 2009.

Eugenia Cordero-García, Federico Jiménez, Verónica León-Rodríguez, Karina Salazar-Valerio

University of Costa Rica and Central Pharmacy, Mexico Hospital.

Abbreviations: CCSS (Costarican Social Security System); ODL (official drug list).

Correspondance:

eugenia.corderogarcia@ucr.ac.cr

Abstract

Background and aim: Within the population attended by the Costarican Social Security System (CCSS), there exists a minority group with unique needs of certain drugs due to their differential clinical condition. In this situation of importance, although only constituted by a minority of cases, the CCSS provides a system for acquiring "transit drugs" and those which are outside of the Official List of Medicines. The acquisition process involves a variety of Public Administrative Procurement procedures established by law, which affect the prescription of medication to the patient. This study aims to analyze the duration of the process of public procurement and bidding involved in the direct purchases of drugs not in the official list of medicines by the Hospital Mexico in 2009.

Methods: In this research we reviewed a 47.26% of the total population of public procurement records, corresponding to 112 of the 237 direct procurement and tendering records which are listed in 2009, according to the Historical Procurement of 2009.

Results and conclusion: It was determined that there is a high variability between different public procurement processes, and between different processes carried out in each of these posters. There is no uniformity in regard to the procurement processes, making it difficult to determine the factors that hinder them.

Keywords: Medicine, public procurement process, competitive bid procedure

The Costarican Social Security System (Caja Costarricense de Seguro Social or CCSS) was created on november 1st 1941, as a semi-autonomous institution protected by the law. In 1943, with a reform of the law, it became an autonomous institution, which since then, has become the entity responsible for the health and sanitary well-being of the costarican population, by means of an universal comprehensive attention; being one of its mainstays the access, acquisition and distribution of drugs.¹

Nevertheless, since 2004, defects in the drug inventory and distribution system have been demonstrated, and buying one drug could require thirty three different steps and also needs the access and/or approval of eighteen different bureaus inside CCSS, consuming many months during this process.² This has lead, in many cases, to shortage of existence of products for as long as over one year.³

The model and concept of "Essential Drug List" were both developed by the World Health Organization (WHO) in the decade of the 1970's, with the purpose of favouring drug accessibility under the premise of a rational use in developing countries.^4-7 One of the basic strategies that support such policies, is the one of esential drugs. Esential drugs are defined as "drugs that satisfy the priority health needs of the majority of the population"; this term refers to those drugs that are priority to attend morbidity of 97% of costarican population.⁵

The central level of the institution, through the Logistics Management and head offices attached to its structure, will be responsible of acquiring, as determined by Law 6914 (Special Drug Law) and its regulations, and also Law 7494 (Administrative Hiring Law) and its regulations, all those storable drugs that solve the principle causes of morbidiy and mortality that affect the countries population, that by its consumption and significative adquisition volume generate scale economies.⁸

This "exceptional drug" is one that is acquired for a special clinical scientific condition developed by a patient, an unfavorable evolution of a given pathologic condition, or because there is no adequate response to the available therapeutic options in the ODL amongst others, so that the exceptionality is recognized because the clinical condition exits the standard.⁶

The procedure of buying a no ODL drug initiates with the detection of the necessity by the treating physician, approval of the request by the Local Pharmacotherapy Committee and afterwards by the Central Pharmacotherapy Committee, estimate of the purchase at the hospital, verification of the budget, which concludes with the administrative decision to initiate it. Subsequently, the posters are made with the help of different proffesionals from the institution in its technical and financial part. After the posters are made, the possibility opens for challenge during the first third of the period, having this comptroller organ a ten day term to have a resolution. After the offers are presented, a revision period opens followed by awarding. After the final challenge decision is published or communicated, the possibility to appeal the administrative decisión opens, for which the Comptrollership has a term of forty working days to resolve after the appeal has been admitted.^9,10 Being there appeals to the posters, the maximum time consumed by the patricipation of the Comptrollership is ten working days or half a month. In the case of appeals, we would sum 10 days to admit the appeal, plus the 40 days to resolve, which gives us a total of 53 days or approximately two and a half months, for a total of 3 months.^9-11

Methods

A cuantitative investigation was performed, based on observable and quantifiable aspects. It was carried out in the Pharmacy Department of Mexico Hospital, more specifically the Purchase and Internal Control Unit. Belonging to the CCSS in la Uruca, San Jose.

In this investigation a 47.26% of the total population of purchase files were revised, corresponding to 112 of the 237 direct and tender purchases that appear registered in 2009, according to the 2009 Purchase Registry.

For this purpose, the files of each one of the purchases were used and previously solicited to the Acquisitions Subarea Office in Mexico Hospital (after previous selection from the drug purchase database of 2009 from the Purchase Office), of the Pharmacy Department.

The files were requested through three lists authorized by the pharmacy's subdirector. To make the lists, the data base was researched for those drug purchases made in 2009 that reported the contest number, because this is a requisite for the request. To determine which purchases should be analyzed an inclusion criteria (direct and public tender purchase from january to december 2009) was applied; and as an exclusion criteria acute, without bidders or unsuccessful purchases.

The previously especified was done through the review of each one of the purchase files during the stablished period, and the time in each part of the process was cuantified. For the time cuantification, the entry and discharge dates were used, the difference between these two dates allows the determination of the duration in days of each step of the purchase process, the total process was defined in months.

Results

To the development of the investigation, a sample of 112 purchase files were revised, of those files, 37 were excluded of the study because they were acute purchases, 3 because they were declared unsuccessful or without bidders, and 3 because they were purchased through article 117. These, for a net sample of 69 files. No public tender file was analized.

According to data shown in table 1, the average of total duration in the process of administrative hiring for the purchase of no ODL drugs and transit in 2009 was of 155.73 days, this value represents the time it takes for the drug to get to the building of Mexico Hospital from the moment the purchase is authorized. The data obtained also showed that the time needed to resolve rectifications in the process of direct purchase in Mexico Hospital during 2009 was an average of 9,81 days (SD 12,32 days).

It was observed, that the longer duration corresponds to processes made before the publication of the posters; and also once it is awarded, in the processes made in the procurement.

Table 2 details the different processes that include the purchess procedure according to the stablished by the aquisitions subarea and the approximate time it takes in its achievement, it is important to point out the great variation in the two principal procedures that goes from 5 to 35 days.

Conclusion

The average total duration of the administrative hiring process for the purchase of no ODL drugs and transit in 2009, was of 155.73 days. If the hospital does not count with a reserve of the drug, this data also represents the average time that a patient has to wait to obtain the treatment once the Pharmacotherapy Committee has approved the purchase of the drug. The importance of this data lies in being able to program the purchase of these drugs to satisfy the demands of the patients, or to search for appropiate mechanisms to speed up the process so the patient has the treatment as soon as possible.

There are factors for which there is a higher level of control, as in the offer presentation on behalf of the distributers and interested farmaceutical laboratories. This time has to be stablished according to the ranks stipulated by law, although there are variations between the different posters, the stipulated in the drugs specifications must be fulfilled. This prevents major delays in the process (average observed of 17.87 ± 13.81 days).

Once the offers are delivered, these have to go through administrative analysis, from which, the head offices of the Pharmacy Department deliver the technic recommendation in the aquisitions subarea. These processes, posterior to the delivery of the offers, suffer high temporal variability due to diverse factors that can affect them and are not the objectives of this study.

After being received in the aquisitions subarea it goes to the financial department, and the awarding is made, being it received afterwards in administration, the principal source of delay in these areas are the errors in the development of the awarding.

Shown in the results, are similar and even higher standard deviations than the average value of days of one of the processes considered in the purchase of a drug. These high variations are due in some cases to the extra time requested by the companies to deliver the drugs in a determined time after the one initially stablished and to the presentation of rectifications on behalf of the bidders, among others.

The review of the purchase files of the different contests, determined that in the mayority of the cases, after publishing the posters, the times are fulfilled according to the stablished by law, although these times are hindered by the rectification process and the revocation resource that can be presented once the contest is awarded.

The enterprises that participate in the contest have two days to make the rectifications, nevertheless, the process can strech because more than one rectification has to be resolved for the same contest. And so, the resolution of the rectifications delays the awarding and constitutes a factor that extends the time of the purchase, but is not constant in every contest.

Among the principal limitations found, was determining the population size to initiate the development of the investigation. The first thing is that there is no complete registry of the drug purchase made in 2009, both the record of purchases and the data base are incomplete, and because of this an exact number of purchases could not be determined, causing problems to stablish the total population of files to review.

Taking into account the results obtained in this investigation, it is relevant to perform an analysis of the purchase of no ODL drugs and transit in the other hospitals of the institution, with the finality of improving the process and speeding the purchase of these type of drugs.

Translated by: Dr. Diana Ulate Ovares

References