The public service of , is in the hands of private operators who won a public tender put out to tender by the Generalitat. In a recent report prepared by the Audit Office, the auditing body denounces “facts that could constitute indications of collusive behavior”, an alleged collusion between the successful bidders that could involve anti-competitive practices and that calls into question the cost paid for each service by the Department of Health through CatSalut. “The irregularities described could give rise to events that could be prosecuted administratively and judicially,” the report states in reference to the companies and those responsible for the decision within the Generalitat.
The Audit Office focuses this accusation on the out-of-hospital outpatient hemodialysis service, for which 16 lots were tendered throughout Catalonia. It was a 10-year tender for an amount of 1,142 million euros in which the major beneficiaries (they achieved 14 territorial packages) and Diaverum. “There are various factors that denote a lack of competition among the participating companies,” says the report, which indicates that the result of the contest was similar to the previous one, called in 2006. One of the arguments is the following: “The geographical distribution of the The awarding of the lots suggests a possible geographical distribution of the market between the 4 successful bidders (Renal Systems, Health and Care Management of Tortosa, Fresenius and Diaverum).” But it also states that monopolistic practices could be explained by a “possible agreement on price fixing and the lack of rotation of offers.” In summary, in the absence of what later reports indicate: “They appropriated an illegal extraordinary benefit that harms the contracting Administration.”
The Audit Office has just signed an agreement with, according to which it would have to send its report so that the ACCO can carry out its own investigations.
The contest dates back to 2014 and was carried out through a negotiated procedure with specialized companies without advertising, despite being required according to the law in force at that time. The cost of each service, point out the trustees who prepared the report, was not established through any sample or cost study. And, it is being underused, below 9% of total cases in 2022 (and with large differences according to territories). According to the Audit Office, this also has a lower cost, of around 29,724 euros, compared to 47,744 euros for out-of-hospital hemodialysis and 42,461 euros for hospital hemodialysis.
“Hospitals that provide home techniques have difficulties financing these techniques because the rates paid by CatSalut are lower in the case of peritoneal dialysis compared to conventional hemodialysis and insufficient to cover their costs in the case of home hemodialysis,” points out the Audit Office, which in another point of its conclusions points out an example of the discretion with which it acts: “The dialysis center that has billed the fewest dialysis sessions out-of-hospital, the Braun center in Martorell, has the most competitive price.”
The report of the Audit Office makes clear from the beginning the relevance of chronic kidney failure treatments: because it is a vital necessity for patients, because of how it affects the quality of patients and, also, because of the high cost which represents for public health, among the most expensive of chronic diseases. In 2022, it will cost a total of 139.5 million euros (22 million more than initially planned). This is why the supervisory body decided to carry out a report on the service in 2022, taking into account several related actors: in addition to Catsalut, the Catalan Society of Nephrology, professionals and user associations.
Their conclusion is that the plan on which the service is provided is “obsolete” and that, despite the needs having increased, the contracted activity has not been updated. The consequences: ten centers exceeded the contracted activity by an amount of 8.4 million without any contract modification occurring. Likewise, the supervisory body attacks the lack, by Catsalut, of an automated circuit that ensures the services provided indicated by the operators: “The name of sessions billed by the providers may not be real.” The Audit Office detected 31,574 records of potentially duplicate invoices for a volume of 4.3 million, although CatSalut alleged that some of these invoices had already been identified and discounted to suppliers.
The lack of monitoring is similar in the case of service quality, in which CatSalut does not control travel times and waiting times in dialysis centers. 10% of patients exceed 7.4 hours between leaving and arriving home after treatment.
