Evolution in Public Procurement for Medical Devices in Italy

OBJECTIVES: Since 2018, in Italy, the public procurement of medical equipment and facilities, among which medical devices, has become compulsorily centralized above defined thresholds of expenditure. Nevertheless, continuity of care should play a key role in design of centralized tenders by purchasing bodies to encourage institutions in their adoption. The aim of this study is to investigate if procurement centralization implementation reform in Italy has increased centralized public procurement of medical devices at national and regional level.

METHODS: To evaluate the centralization of procurement for medical devices in Italy, yearly information published by the Observatory of European tenders was assessed. Firstly, purchase procedures were clustered in three macro-groups: national, regional centralized and sub-regional decentralized. Secondly, it was assessed both the share for each purchase procedure in 2019 (most recent data available) and the variation of centralized acquisition on total procurement, considering respectively the year before and after the 2018 reform.

RESULTS: From 2017 to 2019 medical device purchasing at national level increased from 3.6% to 10.1% of total procurement of medical devices, with regional centralized and sub-regional decentralized purchasing still accounting for 49.1% and 40.8% respectively in 2019.

In 2019, at regional level, thirteen regions out of twenty, implemented regional centralized procurement for more than 50% of total acquisitions, four of which performed a completely centralized procurement and four of which experienced an increased centralization from 2017 to 2019. None of the regions with a centralized procurement lower than 50% in 2019 of total acquisitions experienced a growth.

CONCLUSIONS: The analysis shows that after 2018 reform, there has been a growth in national centralized procurement for medical devices with a well-established regional centralized procurement in more than half of the Italian regions in 2019. Italian policies seem to have increased centralization in public procurement, albeit national non-centralized purchases remain substantial.