Country Perspectives: Italy

What is your professional background and which country insights do you share with us?

I work at European level: 

• From a strategic tender perspective (supporting companies to develop pre-tender strategies). I matured experiences in all EU Countries. 
• From a practical perspective (supporting companies to answer to market consultations) I’ve developed more experiences in Italy, UK and Sweden.

How is procurement in healthcare being organised in your country?

In Italy there is a high level of concentration. The Italian procurement system moved from Hospital Procurement to centralized procurement in a couple of years. Today healthcare public procurement is performed by 21 regional and one national procurement body. I saw the same transformation in UK with one centralised procurement body (Tower) basically dealing for all Hospital supplies. In Sweden I see a lower level of centralisation with local municipal purchasing bodies acting for smaller areas.

What are the current/ main challenges you see in procurement?

In Italy public procurement is perceived as a means to fight corruption. The Centralized Anticorruption Authority (ANAC) issued several soft laws with the goal to increase the level of choices rationality  (e.g. they require to use of highly quantitative awarding criteria instead of discretional criteria) and decrease the impact of a single person on the decision outcome (e.g. awarding commission in Italy should be chosen randomly from a list of potential commissioners that respond to high integrity standard). 

The quest of rationality that leads to prefer quantitative (objectively measurable) awarding criteria risk to flatten the differentiation to those quality aspects that are easily measurable (e.g. you can quantitively assess fuel car’s consumption but how can you assess a car’s safety  in case of a crash at 130 km/h?). 

There is the tangible risk that objective awarding criteria will slow down innovation adoption since claims in the Health Care sector need to be confirmed by evidence and innovation are usually baked by lower level of evidence  (e.g. developing clinical evidence is costly and time consuming therefore newly launched products usually aims to prove that they are safe and at least as effective as the standard of care)

What will procurement look like five to ten years from now?

There is a progressive harmonization at EU level. I think the EU countries that are not implementing the Public Procurement Directive (like Germany) will slowly adopt it.  The overall communalities within EU countries will increase. Harmonization does not mean equality. There will always be some differences e.g difficult to think that the procurement approach in Italy (which is ranked 51 in the perceived corruption index) will be the same of Denmark (which is ranked 1 in the same index) but  similarities will definitely increase.

Which insight / experience would you like to share most with the European procurement community?

• Procurement decisions have a direct impact on patient’s lives.
• Healthcare procurement should always lead to improved patient’s outcome.
• Patient’s outcome could be improved with better products and enabling physicians and health care institution to perform their job better. 

The scarcity of protection equipment during the Covid-19 crisis showed how lowest price procurement policies may have favoured outside EU suppliers that have reached economy of scale where direct production costs are lower. This finally exposed EU health care workers and patients to the scarcity of protective material during the outbreak.

We must remember that public procurement choices have a direct impact on political issues. For example, we should consider the environmental impact that low-cost producer may have in developing countries. We should not accept that lowest prices policies weaken the competitive position of EU producers.