Institute of Health Policy,Management and Evaluation, University of Toronto.
Department of Health Management,Evaluation and Policy,University of Montreal, Institute of Public Health Research of University of Montreal (IRSPUM).
Int J Technol Assess Health Care. 2019 Jan;35(1):50-55. doi: 10.1017/S0266462318003756. Epub 2019 Feb 8.
Procurement's important role in healthcare decision making has encouraged criticism and calls for greater collaboration with health technology assessment (HTA), and necessitates detailed analysis of how procurement approaches the decision task.
We reviewed tender documents that solicit medical technologies for patient care in Canada, focusing on request for proposal (RFP) tenders that assess quality and cost, supplemented by a census of all tender types. We extracted data to assess (i) use of group purchasing organizations (GPOs) as buyers, (ii) evaluation criteria and rubrics, and (iii) contract terms, as indicators of supplier type and market conditions.
GPOs were dominant buyers for RFPs (54/97) and all tender types (120/226), and RFPs were the most common tender (92/226), with few price-only tenders (11/226). Evaluation criteria for quality were technical, including clinical or material specifications, as well as vendor experience and qualifications; "total cost" was frequently referenced (83/97), but inconsistently used. The most common (47/97) evaluative rubric was summed scores, or summed scores after excluding those below a mandatory minimum (22/97), with majority weight (64.1 percent, 62.9 percent) assigned to quality criteria. Where specified, expected contract lengths with successful suppliers were high (mean, 3.93 years; average renewal, 2.14 years), and most buyers (37/42) expected to award to a single supplier.
Procurement's evaluative approach is distinctive. While aiming to go beyond price in the acquisition of most medical technologies, it adopts a narrow approach to assessing quality and costs, but also attends to factors little considered by HTA, suggesting opportunities for mutual lesson learning.
采购在医疗决策中的重要作用促使人们对其提出批评并呼吁加强与卫生技术评估（HTA）的合作，这就需要详细分析采购如何完成决策任务。
我们审查了加拿大用于患者护理的医疗技术招标文件，重点关注评估质量和成本的征求建议书（RFP）招标，并辅以所有招标类型的普查。我们提取数据来评估：（i）作为买家的团体采购组织（GPO）的使用情况，（ii）评估标准和评分细则，以及（iii）合同条款，这些都是供应商类型和市场状况的指标。
GPO 是 RFP（54/97）和所有招标类型（120/226）的主要买家，RFP 是最常见的招标（92/226），很少有仅价格招标（11/226）。质量评估的标准是技术标准，包括临床或材料规格以及供应商经验和资质；“总成本”经常被提及（83/97），但使用不一致。最常见的（47/97）评估细则是总分，或在排除强制性最低分之后的总分（22/97），其中大多数（64.1%，62.9%）权重分配给质量标准。在规定的情况下，与成功供应商的预期合同期限较长（平均值为 3.93 年；平均续约期为 2.14 年），大多数买家（37/42）期望授予单一供应商。
采购的评估方法是独特的。虽然采购在获取大多数医疗技术时旨在超越价格，但它对评估质量和成本的方法很狭窄，但也关注 HTA 很少考虑的因素，这表明双方有相互学习的机会。
