Criticisms of “millions parties” and procedures with a risk of corruption against the Health Insurance Agency (OAY) both in relation to the purchase prices of drugs and consumables were heard at today's session of the Parliamentary Audit Committee, which examined the Administrative Audit it conducted the Audit Service of the Republic.
The report, as stated in his statements after the session by the Chairman of the Committee, DIKO MP, Zacharias Koulias, demonstrated “the big party that is held with taxpayers' money” recalling that the expenditure for the General Health System was initially calculated under from €0.9 billion and is now at €1.5 billion, while the Ministry of Health covers several medicines with its own expenses.
Mr. Koulias strongly criticized the OAU regarding the purchase of medicines, the fund for which in some cases shows an increase of up to 1600% compared to the prices at which the Ministry of Health bought in the pre-GeSy era.
He referred to a medicine that the Ministry of Health bought for €6.30, while the OAU buys it for €29.32, increased by 375%, or another medicine that the Ministry of Health bought for €3.68, while the OAU buys it for €18.15. He also referred to prosthetic knees which the Ministry of Health bought for €1,234 while the OAU buys them for €8,000.
“They came in with the tsarouchias,” said Mr. Koulias, saying a mea culpa for the law passed by the Parliament and the authority it gave to the management of the National Health Service. “All of these cannot be governed by unrelated people,” he said, adding that the responsibility for health systems rests with the Ministries of Health, the scientific community. “Here we put their friends, OEB, KEBE and trade unions”, he said, adding that he is in consultation with MPs for a possible change in the administration of the OAU and OKYPY, as he said.
Procedure of high risk of corruption
In informing the Commission, the Auditor General of the Republic referred to consumables (category G) procured by OAU, which did not follow the previous process of public tenders, but buys through lists drawn up by itself. He mentioned, for example, prosthetic knees, which the OAU chose, while each doctor chooses the product from whichever specific supplier he chooses and the Organization pays for it.
“Everything is paid at the same price. This is high risk for issues of corruption, corruption between doctors and suppliers or hospitals and suppliers,” he said.
Saying that the Audit Service was alarmed to see the whole system, he questioned “how OKYPY, which is a public body, instead of open bidding processes, can choose what it wants from a list?”, adding that in March 2022 a big difference was found in prices of consumables purchased by the OAU compared to the prices purchased by the Ministry of Health.
Mr. Michaelides acknowledged that there are exceptions that give the OAU the opportunity to negotiate with suppliers, but added that the exceptions have become the rule. “We do not agree that this massive use of the negotiation process was legal and served the public interest,” he said.
He cited as examples that the Ministry of Health purchased a specific pacemaker for €4,500, while the OAU €6,500, another pacemaker while being bought for €5,270 is now bought by OAU for €7,500, or a knee which was bought for €1,234 is now bought for €8,000.
“There was nothing or almost nothing. We found no documentation on how they arrived at these prices,” said Mr Michaelidis.
He noted that it took France two years to draw up list Z, while, as he said, the OAU drew up the list five working days before the start of the 2nd phase of the NHS, i.e. inpatient care.
He noted that because the OAU takes different products, sets a single price, as a result of which it gives margins of profit to the supplier with the lowest price.
He also referred to the example of the antibiotic Augmentin which before GeSY was bought by the Ministry of Health for €2, 04 while now for €7.91.
As he said, in 2018 the expenditure on medicines was €115 million, while in 2021 the OAU paid €134 million, increased by 16.5%.
In relation to innovative medicines, Mr. Michaelidis he said that OAU has a “hidden exit”, since the cost of their purchase is paid by the Ministry of Health, through the Generic Medicines Committee.
A larger quantity corresponds to a lower price
The Director General of the Ministry of Health, Christina Giannaki, agreed with the remarks of the Auditor General, stressing that through the bidding process, the Ministry of Health ensured lower prices compared to the wholesale price, which in some cases reached up to 1,600% lower, especially in the market of of generic drugs.
Mrs. Giannaki reminded that for the NHS the Ministry of Health made purchases to meet the needs of 600,000 beneficiaries, while with the introduction of the system the beneficiaries increased to 950,000, which should lead to lower prices due to the increased quantity.
“In the science of economics, including pharmaceutical economics, quantity is a subject of negotiation since buying a larger quantity corresponds to a lower price,” he said. He noted that the sums that would be saved from the lower prices could be allocated for inclusion in the NHS list of new innovative medicines.
We keep cancer patients alive
Ms. Giannaki was very vocal about the patients supported by the Ministry. Saying that the Ministry is willing to support the Medicines Advisory Committee at the OAU, Mrs. Giannaki underlined that “it is important that today a sick person who is a cancer patient cannot write to us and we can help them”.
“The cancer patient is a beneficiary of the NHS and from the moment he is a beneficiary these medicines belong to him, and the medicines are not a la carte. We don't start a treatment and stop it, no. We have people with cancer who have been keeping them alive since 2016, and this Ministry of Health. We will continue as a state to help the OAU, but they will have to take on this great responsibility”, he underlined.
€45 million for inclusion of new drugs
Replying, the new President of the OAU, Stavros Michael, asked for time credit to examine the issues that arise.
“The findings of the Auditor General will be studied and we will try to implement best practices to improve it. Yes, there are problems, there are distortions, the NHS was introduced somewhat hastily, it is in its infancy, there is room to implement better practices. Give us some time and we as an Organization day by day, piece by piece, want to improve it”, he said.
Regarding the issue of drug prices, Mr. Michael said that there are answers, adding that in some places the prices are not comparable, while there are also cases where the prices have been reduced, “we will have to look at it comprehensively”, he added.
He said that the OAU has increased its budget by €40 to €45 million to intensify the innovative medicines on the OAU list, with the timetable extending until the beginning of 2023.
But he asked for support with three new pharmacist positions to introduce protocols to speed up the SEF project. “And we will be able to include within 2023 90% of innovative medicines,” he said.
The Oversight Commissioner of the NHS, Christodoulos Kaisis, agreed with the remarks, while he referred to complaints in relation to co-payment 2 concerning pensioners, who take a lot of medicine and now pay more. Mentioned nutritional supplements or pain medications or other treatments, which are now not covered or have an increased copayment. “We are concerned about change. An elderly person who is regulated for sugar and pressure cannot now change his contribution,” he said.
At this point, Ms. Giannaki referred to the well-known Voltaren, which was paid for before GEΣSY, while now it is not.
The bidding process is not compatible with the mission of the OAU
The official of the General Accounting Office said for his part that the process of public tenders is not compatible with the mission of the OAU, since there are multiple suppliers.
In particular for list Z (consumables) he said that our position is that it is legal, as there are decisions of the European Court because the specific procedure does not concern a specific contractor.
At this point Zacharias Koulias replied that these which he says is not legal, with DISY MP Savia Orfanidou retorting that he is “bowling to a public official”.
Furthermore, in statements after the session, EDEK President Marinos Sizopoulos said that from the discussion ” there is a serious waste of public money and mainly of taxpayers' contributions”.
“It is no coincidence that 2.5 years after the implementation of the NHS, the global budget of €900 million has today reached €1.5 billion, essentially putting the sustainability of the Public Health System at serious risk,” he said.< /p>
In her own statements, Savvia Orfanidou said that there is a lot of room for improvement regarding the inclusion of innovative medicines based on the legislation and she completely agreed with the recommendations of the Auditor General and the Ministry of Health. He expressed satisfaction for the statements of Stavros Michael that he sees the distortions and weaknesses and that he will implement the legislation with the inclusion of innovative drugs, always with the ultimate goal of benefiting the patient.
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