Trends and changes in the relationship between quality and price in tenders for healthcare services in the Israeli health system, 2013-2023.

BACKGROUND AND OBJECTIVES

Public healthcare systems face constraints in financial and professional resources. The Mandatory Tenders Law 5752 - 1992 stipulates that before entering into a contract for the supply of a service or product, public authorities and government corporations must undergo a public tender process. The authors sought to identify and contextualize the trends observed in tenders for healthcare services over the past decade amid increasingly stringent resource constraints. What prevails over what: quality or price?

METHODS

All tenders for services provided by health professionals published by the Ministry of Health and health maintenance organizations between 2013 and 2023 were collected. Each tender was assessed for the quality and price components. Trends in the quality and price percentage were evaluated.

RESULTS

A total of 224 tenders were analyzed. A statistically significant weak negative correlation was found between the quality percentage and years (r=-0.185, p < 0.01), indicating that quality percentages tended to decrease over the years. The quality percentages statistically significantly decreased by 10.14% points during the COVID-19 period (p < 0.05). The median quality percentage of tenders for health services directly impacting patients over extended periods was statistically significant higher compared with the median quality percentage of tenders for health services having indirect impacts on patients (p < 0.05).

CONCLUSIONS

Despite healthcare organizations prioritizing quality and seemingly assigning it a higher weight in tenders, price is often the decisive factor. Effective mechanisms to safeguard the quality and safety of healthcare services in addition to incorporating economic considerations into tender processes should be established.