Public Procurement of Medicines: A Taxonomy of Procurement Systems in Europe

OBJECTIVES: Public procurement of medicines has the potential to improve patient access to medicines. While the European Union (EU) and individual countries provide an extensive legal framework around procurement with the aim of promoting a competitive market (e.g. through open calls for tenders), it is unclear how public procurement procedures are organised in European countries and how these systems perform. We aimed to review the organisational set-up and practices for public procurement of medicines in Europe and to develop an empirically based taxonomy of public procurement systems.

METHODS: Firstly, targeted literature searches were conducted to identify publicly available information on public procurement systems and practices in 32 European countries (all EU member states, Iceland, Liechtenstein, Norway, Switzerland, United Kingdom). Information was validated by procurement experts in the study countries. Secondly, public procurement data from the Tenders European Daily (TED) database were reviewed.

RESULTS: The two most common forms of public procurement organisation in Europe are facility-based procurement (mostly in the inpatient sector, where individual hospitals conduct their own procurement) and centralised procurement through a central purchasing body (CPB) at the national level. The latter is often only used for selected categories of medicines, such as medicines used for national health programmes and vaccinations, or high-priced medicines. Other forms of procurement organisation include centralised procurement at the regional level (the dominant form of hospital procurement in some countries) and group-based (or joint) procurement by loose associations of health care facilities. Cross-country joint procurement is not yet widely used across Europe, although individual initiatives have successfully conducted joint tenders.

CONCLUSIONS: Countries typically apply a mix of organisational forms for procurement of medicines. While pooled procurement may hold some advantages, such as greater purchasing power, European countries continue to procure large volumes of medicines at sub-national and, in many cases, at facility-level.