There is uncertainty and apprehension in the medical technology market caused by the fact that we are already in October 2019 but the clawbacks for 2018 have yet to be calculated.

Budget quantification by material category for 2017 and 2018 did not take into account actual needs. Consequently, the rates for 2017 were exorbitant, reaching an astronomical 70% in certain categories.

In the meantime, the Hellenic Health Services Organization (EOPYY) has yet to process crucial data on market growth, such as:

• Progress of expenses during 2018, so as to determine clawbacks
• Budget quantification per category of health services and expenditures of the first semester of 2019

Of course, other major issues still remain unresolved, as for instance the fact that negotiations and procedures regarding the assessment of new medical technology products are unclear and time-consuming. In addition, confusion is caused by the abolition of the Medical Technology Products Registry of EKAPTY (National Evaluation Center of Quality & Technology in Health), before completion of the Registry of the Hellenic Pharmaceuticals Organization (EOF) which is meant to replace it.

Main discussion topics

• Evaluation and negotiations on new medical technology products
• Quantification of EOPYY’s budget for 2019 per category of services
• Calculation of clawbacks for supply of medical materials to EOPYY’s insured for the years 2018 and 2019.

Despite promises of many years, the procurement system for public hospitals has not been re-structured yet. The establishment and operation of the National Central Health Procurement Authority (EKAPY) by the previous government did not make headway, therefore, various distortions and malfunctions related to this problem remain unresolved.

For instance, there are no well-defined procedures for the evaluation and procurement of new innovative materials in Greece, while all over the world the progress in the medical technology sector has enabled the acceleration of the new med-tech products development rhythm. Undoubtedly, the country’s Healthcare System is in urgent need of the application of modern funding models, such the use of Diagnosis-Related Groups (DRGs).

All efforts and promises for the conduction of public tenders, which could potentially contribute to at least 25% saving of funds, were proven to be just empty words.

At the same time, the platform of the National System of Electronic Public Tenders (ESIDIS) is barely used by hospitals for procurements of more than 60,000 €. Indicative of the situation is the fact that, in 2016, tenders that led to contracts amounted to just 136 million, which was reduced to 90 million in 2017 and was even less in 2018. Therefore, it seems that the above platform is used only for 6-9% of the total of procurements.

This essentially means that most hospitals’ procurements are completed without the conduction of public tenders procedures (through extension of existing contracts, direct awards of contracts for low-cost supplies etc.). Thus, these procurements are regularly legalized by the ruling government, so that suppliers can get paid. The last legalization was implemented by law 4623 (Greek Government Gazette Vol. A’ 134, 9/8/2019), which includes all procurements of materials until 31/7/2019.

Furthermore, there are problems regarding payment of debts from non-invoiced supplies of the Hellenic Healthcare System’s hospitals. These are materials accompanied by consignment notes delivered through emergency procedures used in cases of urgent hospital needs – for example emergency surgeries – without having been invoiced, since the legal procedure was not followed. The public hospital “Evangelismos” has the most debt of this type, followed by other big hospitals such as “Ippokrateion Athens Hospital”, “Patras University Hospital”, “G. Gennimatas” and “Nikaia Hospital”.

As if that were not enough, great confusion is caused by the Registry of Medical Technology Products. On March 2019, the previous government abolished EKAPTY’s Registry by voting for law 4600 which introduced the new Registry of EOF (Hellenic Pharmaceuticals Organization).

However, EOF’s Registry has not been created yet. After two extensions to the legal deadline, companies have until the end of December 2019 to comply with the legal provisions. Nonetheless, law 4600 prevails on EOF’s decision for the extension, meaning that EKAPTY’s Registry was substantially abolished before the creation of EOF’s registry which is intended to replace it.

All this has resulted in an unprecedented situation regarding the procurement of medical technology products by hospitals of the Hellenic Healthcare System: a necessary requirement for the delivery of a med-tech product is that its registry number is written on the accompanying document; but since EOF’s Registry is still under construction, most hospitals still accept products that have the EKAPTY Registry number on their invoices or delivery notes. This practically means that many products circulate in the market unmonitored, given that EOF’s Registry is incomplete.

Main discussion topics

• Operation of the National Central Health Procurement Authority (EKAPY)
• Evaluation and compensation for new medical technology products
• Application of DRGs for hospital funding
• Public tenders for the procurement of materials
• Medical Technology Products Registry

Today, the exact number of all medical devices installed in hospitals of the Hellenic Healthcare System (ESY) remains unknown, while there are no operability and evaluation indicators for those that are actually registered. In practice, hospitals have not yet adopted procedures for the registration, codification and systematic monitoring of medical equipment.

The lack of data on the number, type and condition of the machines makes it almost impossible to design a program for the organization and control of medical equipment nationwide. Currently, the acquisition and management of medical technology products is summarily characterized by:

• very low utilization and effectiveness rates
• intense spatial heterogeneity
• lack of evaluation criteria
• promotion of non-rational investment policies

At the same time, procurements and tenders procedures, as applied today, result in complicated and ineffective management of biomedical technology. The required specifications should be based on clinical characteristics which have been scientifically proven to enable the effective use of the product.

Experts underline the urgent need to create a Medical Equipment Cadaster, which will serve as a powerful tool that will enable us to design strategies, develop business plans and make decisions in the medical technology sector, as it will be based on global data and international medical technology evaluation indices.

Main discussion topics

• Medical Technology Equipment Cadaster
• The new government’s priorities regarding the technological modernization of hospitals
• Clinical specifications for equipment procurement
• Maintenance and replacement of medical devices