Global Clinical Engineering
Success Stories
Public Investment on Medical-Hospital Equipment:
Creation of National List of Equipment (RENEM)
and Management System (SIGEM)
Submitted by
Name:
Affiliation:
Location:
E-mail address for contact:
Murilo Contó
PAHO/WHO Consultant
Brasília, Brazil
[email protected]
Country Estimates in Brief
Population
205 million
Population Growth Rate
0.9% year
Life Expectancy at Birth
78,8 – females
71,6 - males
Infant Mortality Rate
15/1000 (live births under 1 year)
Number of Health Centers in Country
64,000 primary health care centers
5,900 - Hospitals
Total Expenditure on Health as % of
GDP
2.9% of GDP (2015) from state budget,
9.1% in total including private sector
January 2016
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Country's Health Technology Program
National List of Equipment (RENEM) and Management System (SIGEM)
Background
• To ensure the actions of the Brazilian Unified Health System (SUS)
can be achieved, MoH provides investment programs for all over
country institution can acquire equipment through project proposals.
• Before the adoption of RENEM, the project proposals were presented
with no definition about the type of equipment and its technical
specification, including equipment or their features without evidences
about their cost-effectiveness ratio.
• The value requested to MoH by
Hospitals were often very above the
market medium prices.
Hospitals
Health Centers
Institutions
Project Proposal
$$$
MoH
March 2016
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Country's Health Technology Program
What we did…
• RENEM was adopted after
nomenclatures culminating in
according to the complexity
eliminating issues of requests
service.
systematic standardization of
equipment combos distributed
of healthcare environments,
not according to their profile
• A technical process with minimum requirements of scientific
evidence and economic evaluations was adopted for new
incorporation of equipment.
January 2016
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Country's Health Technology Program
What we did…
• A computerized system called SIGEM was developed to manage the
structure of RENEM and the entire process of investment analysis. A
tool that performs the historical search of the quantity and value of
equipment financed to each state, city and institution, allowed the
creation of ABC curves and Pareto analysis, identifying the key items of
RENEM that require further attention and the types of equipment and
specifications more requested around the country.
• An automation function was introduced into SIGEM that provides the
technical features of the equipment in multiple choices. Each technical
feature has a monetary value associated that represents the impact on
the final price. Thus, the system performs a dynamic price setting which
automatically adjusts itself to the selected specification in over 100
types of equipment.
January 2016
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Conclusions and Action Plan
Outcomes
• The quality of projects got a meaningful improvement, including only
equipment with features previously approved
• As a main result, the number of investments proposals approved in
2014 (7506) was almost four times higher than the previous year in
2013 (2234)
• With the automatic price setting and limit of prices, the funds were
invested with more efficiency. In 2013 were around US$ 300 million
invested and in 2014 were around US$ 770 million
8000
7522
7506
7000
6000
5000
4000
3000
2000
1000
0
576
464 112
2010
710
570
140
2011
Approved Projects
January 2016
1809
1530
279
2012
Denied Projects
2512
2234
278
2013
16
2014
Total
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Conclusions and Action Plan
Outcomes
• Pre-approved technical specifications for each equipment based on
demand and cost-effectiveness evidences;
• Direct impact about the financial funds optimization, providing the
financing a bigger number of projects and more equipment, what
means a bigger technological assistance coverage; and
• Equipment with more safety and efficiency offered to population,
what means a decrease the Total Cost of Ownership to
management during all cycle of life, for don’t incorporate equipment
with functions and resources without needs and with meaningful
impact on acquisition and maintenance costs.
January 2016
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Action Plan
Action Plan
• Increase the number of equipment on RENEM with a dynamic price
setting to 200 equipment;
• Others steps of investment project proposals automatized to get
more dynamism on approbation;
• Continuous updating of technical specifications and equipment
prices.
January 2016
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