Assessment of drug bidding and the results of using bid winning drugs at 105 military hospital from 2015 to 2017

Assessing the procurement of drugs and the results of using drugs for bidding at 105 Military Hospital from 2015 to 2017. Methods: Using retrospective study plan and bidding results for drug purchase.

Journal of military pharmaco-medicine no9-2019 ASSESSMENT OF DRUG BIDDING AND THE RESULTS OF USING BID-WINNING DRUGS AT 105 MILITARY HOSPITAL FROM 2015 TO 2017 Ho Canh Hau1; Nguyen Minh Chính2; Hoang Hai2 Nguyen Thi Lan Huong1; Nguyen Thi Tam1 SUMMARY Objectives: Assessing the procurement of drugs and the results of using drugs for bidding at 105 Military Hospital from 2015 to 2017 Methods: Using retrospective study plan and bidding results for drug purchase Results: Having develop a list of hospital drugs in 2015 of 545 items, and 675 items in 2016, and 719 in 2017 Develop a list of bidding drugs: In terms of amounts, in 2015 it was 987 items/226 active ingredients, in 2016 it was 503 amounts/292 active ingredients, in 2017 it was 642 items/386 active ingredients Result of purchase: in 2015, it was 340 items, in 2016 it was 332 and in 2017 was 441 items Results used for health insurance subjects: 2015 was 356 items, 2016 was 354 items and in 2017 was 434 items Conclusion: Develop a list of hospital drugs in 2015 - 2017 from 545 to 719 Developing a list of bidding drugs: not rational for years The result of buying increased from 340 to 441 items in period of 2015 - 2017 * Keywords: Drug bidding; Purchase and use of bid-winning drug; 105 Military Hospital INTRODUCTION Article 44 of the Law on Bidding No 43/2013/QH13 states that “Centralized procurement is a way of organizing tenders widely to select contractors through concentrated procurement units in order to reduce costs, time and clues organize bidding, enhance the professionalism in bidding, contribute to increasing economic efficiency”[1] Guiding and implementing the Bidding Law No 43 and Decree 63/2014/ND-CP [2] with Circular No 11/2016/TT-BYT providing regulations on bidding for drugs at health facilities and the Circular No 09/2016/TT-BYT issues 106 active ingredients required for concentrated local procurement [3], [4] According to the regulations on concentrated drug biddings, there were 59 nationallevel bids, 106 local-level concentrated biddings and negotiated prices Thus, compared to 1,091 western medicines (issued under Circular No 09/2016), medical facilities organize their bidding if required 105 Military Hospital Vietnam Military Medical University Corresponding author: Ho Canh Hau ((dshocanhhau2019@gmail.com) Date received: 01/10/2019 Date accepted: 27/11/2019 181 Journal of military pharmaco-medicine no9-2019 From 2015 to 2017, bidding at health facilities will follow the guidance of Circular No 01/2012/TT-BYT [5] and Circular No 11/2016/TT-BYT (from July 1, 2016) During this period, evaluation of the procurement of drugs and the use of drugs at 105 Military Hospital which practical and urgent in conducting the bidding for the following years at the research unit Thus, the aims of this study were: To assess the drug bidding and the results of using bid-winning drugs at 105 Military Hospital from 2015 to 2017 SUBJECTS AND METHODS Subjects Legal documents, hospital drug list, drug bidding list and bid-winning drugs list at 105 Military Hospital from 2015 to 2017 Methods Using retrospective method to evaluate the drug bidding results and the drug procurement through the bidding from the list of hospital drugs, the list of bidding drugs and the list of procurement by bid at 105 Military Hospital from 2015 to 2017 RESULTS From 2015 to 2017, 105 Military Hospital conducted extensive bidding to purchase drugs Evaluation of bidding and procurement of drugs by bid was shown below Develop a list of hospital drugs The hospital's drug list serves as a basis for developing a list of bidding and use drugs during the year From 2015 - 2017, the list of hospital drugs was shown in table Table 1: VEN analysis of the list of hospital drugs from 2015 - 2017 Year Group 2015 2016 2017 Amount Ratio (%) Amount Ratio (%) Amount Ratio (%) V 109 20.00 132 19.56 120 16.69 E 347 63.67 397 58.81 408 56.75 N 89 16.33 146 21.63 191 26.56 545 100.00 675 100.00 719 100.00 Total The analysis results in table showed: - List of hospital drugs had been built up year by year: 545 items in 2015, 675 items in 2016 and 719 items in 2017 Thus, compared with 2015, the figure increased by 130 items in 2016 and 174 items in 2017 - The number of drugs in categories V and E decreased, while the amount of drugs in group N increased from 16.33% in 2015 to 26.56% in 2017 182 - The list of hospital drugs and the process of increasing the amounts must be selective, in accordance with the following requirements: + Ensuring consistent with disease patterns and costs of drugs used for treatment in hospitals: Focusing on health insurance subjects + Appropriate in terms of technical expertise: Grade hospital Journal of military pharmaco-medicine no9-2019 + Respond to new methods, new techniques in treatment + Limit the use of some drugs of great value or drugs with serious adverse reactions, drugs that are in doubt about the effectiveness of treatment - It is necessary to cut down the drugs in group N and strengthen the drug group E (the essential medicine group) According to the proposal of the project, it is necessary to reduce the group of N drugs to below 10% in order to concentrate funding for group E Developing a list of bidding drugs * Compare the list of bidding drugs and the list of hospital drugs: Table 2: Comparison of hospital drugs list and bidding list of drugs from 2015 - 2017 Year Index 2015 2016 2017 Amount Active Amount Active Amount Active The list of bidding drugs (1) 987 266 503 292 642 386 The list of hospital drugs (2) 545 456 675 474 719 512 181.10 58.33 74.52 61.60 89.29 75.39 % (1)/(2) - Develop a list of bidding drugs compared to the list of hospital drugs with a number of items accounting for 181.10% in 2015; 74.52% in 2016 and 2017 was 89.29% - The number of active ingredients accounted for 58.33 - 75.39% in years This result showed that there was no link between the bidding list and the list of hospital drugs * Analysis of the list of bidding drugs according to ABC: Table 3: List of bidding drugs according to ABC analysis from 2015 - 2017 Year 2015 2016 2017 Amount (%) Ratio (%) Amount (%) Ratio (%) Amount (%) Ratio (%) A 13.58 75.02 14.91 75.22 18.69 75.14 B 15.40 15.03 16.50 15.04 16.04 15.00 C 71.02 9.95 68.59 9.74 65.26 9.86 100.00 100.00 100.00 100.00 100.00 100.00 Group Total - To achieve about 75% of funding (group A), the number of items in 2015 accounted for 13.58%, 14.91%; 18.69% in 2016 and 2017, respectively - To achieve about 10% of funding (group C), the number of items in 2015 accounted for 71.02%, 68.59% in 2016 and 65.26% in 2017 The above results were not reasonable, showing that the percentage of group A in the list of drugs for bidding next year was higher than the previous year, while group C gradually decreased 183 Journal of military pharmaco-medicine no9-2019 * Compare the number of items in the list of budding drugs with the list of hospital drugs by VEN analysis: The percentage of groups V, E, N in the list of bidding drugs and the list of hospital drugs from 2015 to 2017 was shown in figure Figure 1: Percentage of groups V, E, N in the list of bidding drugs and the list of hospital drugs - The percentage of groups V, E, N between bidding drugs and hospital drugs in a year was quite different: Group V in 2015 was about 3% apart, 7% in 2016 and 4% in 2017 Group N in 2015 was about 6% different, about 3% in 2016 and 2% in 2017 - In years, the proportion of groups V, E, N in bidding drugs was not proportional Group V in 2015 was 22.49%, in 2016 it was 17.5% and in 2017 it was 28.35% Group N in 2015 was 22.90%, in 2016 it was 27.04% and in 2017 it was 22.27% List of purchased and used drugs * Compare the list of bid-winning drugs with the list of purchased drugs according to ABC analysis: Table 4: Comparison of bid-winning list and list of purchased medicines according to ABC analysis from 2015 - 2017 Year Drug list 2015 2016 2017 A B C A B C A B C Amount 134 152 701 75 83 345 120 103 419 Ratio % 13.58 15.40 71.02 14.91 16.50 68.59 18.69 16.04 65.26 Amount 41 48 251 48 52 232 68 67 306 Ratio % 12.06 14.12 73.82 14.46 15.66 69.88 15.42 15.19 69.39 Bidding Purchased 184 Journal of military pharmaco-medicine no9-2019 - In order to achieve about 75% of the cost for drugs of group A, the list of drugs bidding for years accounted for 13.58 18.69% of the total items, while the list of purchased drugs according to bidding results accounted for 12.06 - 15.42% - In order to achieve about 10% of the cost for drugs of group C, the bidding list from 2015 to 2017 accounted for 65.26 71.02% of the items, while the list of purchased drugs accounted for 69,39 73.82% - There was no positive proportion among drug groups A, B and C between the bidding list and the procurement list from 2015 - 2017 - The use rate of high value drugs (group A) increased year by year (from 12.06% to 15.42% in 2017) * Compare the list of bid-winning drugs with the list of purchased drugs according to VEN analysis: Table 5: Comparing list of bid-winning drugs and list of purchased drugs according to VEN analysis Year Drug list 2015 2016 2017 V E N V E N V E N Amount 226 539 222 136 279 88 143 317 182 Ratio % 22.90 54.61 22.49 27.04 55.47 17.50 22.27 49.38 28.35 Amount 81 180 79 106 165 61 120 244 77 Ratio % 23.82 52.94 23.24 31.93 49.70 18.37 27.21 55.33 17.46 Bidding Purchased In 2015, the list of bidding drugs and the list of procured drugs was quite similar in all groups V, E, N In 2016 and 2017, the proportion among groups V, E, N was different: - In group V: The list of procured drugs increased by around 5% compared to the list of bidding drugs - In group E: In 2016, the list of purchased medicines decreased by 6% compared to the list of bidding drugs; by 2017, on the contrary, the list of purchased medicines increased by about 6% compared to the list of bidding drugs This result showed that the construction of the bidding list of drugs was not close to the demand for use in 2016 and 2017 * Compare the list of bid-winning drugs with the list of purchased drugs according to ABC/VEN analysis: Analysis of groups, of which group I was AV, AE, AN, BV and CV (the most important drug group), group II was BE, BN and CE (important drug group) and group III was CN (less important drug group) in the ABC/VEN matrix as a percentage of the number of items shown in table 185 Journal of military pharmaco-medicine no9-2019 Table 6: Comparing list of bid-winning drugs and list of drugs purchased according to ABC/VEN analysis Group Purchased 2016 2017 I II III I II III I II III Amount 327 505 155 193 254 56 229 299 114 Ratio % 33.13 51.17 15.70 38.37 50.50 11.13 35.67 46.57 17.76 Amount 113 175 54 140 151 41 169 219 53 Ratio (%) 33.24 50.88 15.88 42.17 42.48 12.35 38.32 49.66 12.02 Drug list Bidding 2015 - The percentage of groups I and II of bid-winning drugs completed quite similar In group III, the ratio fluctuated quite a lot: in 2015, it accounted for 15.70%, in 2016 it decreased to 11.13%, in 2017 it increased to 17.76% - Compare the percentage of bidwinning drugs with the percentage of procurement: The proportion in all three groups fluctuated slightly (the highest was in group III, when the buying ratio was lower than bidding at about 6%) - Percentage of purchased drugs in groups over years of fluctuating was not proportional The results in group III (less important drug group) decreased from 15.88% in 2015 to 12.02% in 2017 This result showed that the hospital has paid attention and cut down on less important drugs in shopping * Results of procurement and use of drugs for medical insurance subjects: 105 Military Hospital has examination and treatment for main subjects: Army policy; health insurance and medical services Depth analysis of drug use results for health insurance subjects was shown in table 7, Table 7: Medicine results used by origin of health insurance subjects Drugs Indexes Items Value (milion) 2015 2016 2017 DPM ID DPM ID DPM ID Amount 158 198 172 182 203 231 Ratio % 55.62 44.38 48.59 51.41 46.77 53.23 Value 4,207 12,234 5,744 15,500 9,865 22,333 Ratio % 25.59 74.41 27.04 72.96 30.64 69.36 (DPM: Domestically produced medicine; ID: Imported drugs) The number of items of domestically procured drugs was equivalent to that of imported drugs for years, but the value of imported drugs always accounted for a large proportion, about 70% in years 186 Journal of military pharmaco-medicine no9-2019 Table 8: Results of using brand-name drugs for medical insurance subjects (Unit: Million VND) 2015 Used drugs 2016 2017 Amount Value Amount Value Amount Value Brand name 30 2,192 48 5,607 49 9,343 Total drug 356 16.441 354 21.244 434 32.198 % brand name 8.43 13.33 13.56 26.39 11.29 29.02 The value of imported drugs has focused mainly on the original brand-name drug The used items accounted for about 10% in years, but the used value increased from 13.33% in 2015 to 29.02% in 2017 - Results of the list of drugs used: 545 items in 2015, 673 items in 2016 and 719 items in 2017 In particular, the amount of non-essential drugs (N) increased from 16.33% in 2015 to 26.56% in 2017 From results of tables and 8, it can be demonstrated that: - Implementing the bidding results: In 2015 and 2016, it exceeded 50% of the bidding results, and in 2017 only achieved about 50% of the bidding results - It is necessary to focus on managing the amount of used drugs for the brandname drug group, because this is a highcost drug group, increasing the cost of medical examination and treatment by health insurance subjects - Priority should be given to the development of domestically manufactured drugs to reduce the cost of use of drugs, and at the same time to meet the Ministry of Health's "Vietnamese people give priority to using Vietnamese drugs" project [6] CONCLUSION - Building a list of hospital drugs: 545 items in 2015, 673 items in 2016 and 719 items in 2017 In particular, the number of items in non-essential medicine group (N) increased from 16.33% in 2015 to 26.56% in 2017 - Building a list of bidding drugs: 987 items in 2015, 503 items in 2016 and 642 items in 2017 The active ingredient accounted for 58.33 - 75.39% in years REFERENCES National Assembly Bidding Law No 43/2013/QH13 Entry into force July 1, 2014 2013 Government Decree No 63/2014/NĐ-CP Detailing a number of articles of the Bidding Law regarding contractor selection 2014, June 26 Ministry of Health Circular No 11/2016/TT-BYT Regulate the bidding for drugs at public health facilities 2016, May 11 Ministry of Health Circular No 09/2016/TT-BYT Promulgate the list of concentrated bidding drugs and the list of drugs subject to price negotiation 2016, May 5 Ministry of Health Circular No 01/2012/TTLT-BYT-BTC Guidance on bidding for purchasing drugs in health facilities 2012, January 19 Ministry of Health Decision No 4824/QD-BYT dated December 3, 2012 of the Minister of Health, approving the project "Vietnamese people give priority to using Vietnamese drugs 2012 187 ... through the bidding from the list of hospital drugs, the list of bidding drugs and the list of procurement by bid at 105 Military Hospital from 2015 to 2017 RESULTS From 2015 to 2017, 105 Military Hospital. .. list of bidding drugs * Compare the list of bidding drugs and the list of hospital drugs: Table 2: Comparison of hospital drugs list and bidding list of drugs from 2015 - 2017 Year Index 2015. .. drug list, drug bidding list and bid- winning drugs list at 105 Military Hospital from 2015 to 2017 Methods Using retrospective method to evaluate the drug bidding results and the drug procurement