Social values and public procurement in health: can ‘smart’ procurement enhance justice in health?

Abstract

Abstract Governments spend 29% of total expenditure on procurement while the second largest area is health. However, the important question is what the impact of these expenditures on health is. Can one buy health justice through procurement? In order to answer this issue, the study firstly analyses theory of global health governance to substantiate whether procurement is a health governance tool whose efficiency and effectiveness determines health outcomes. Secondly, health as a social aspect is scrutinised because its governance and procurement have to be driven by a normative value. Within the study, health justice is justified to be such a value as it is a significant public health factor in practice. Following this normative claim, the study uses analysis of legislation, case law and examples from procurement practice to show whether procurement law can enhance health justice. In terms of methodology, the study establishes a normative framework of governance in health, health justice and procurement. On that basis, it distinguishes procurement categories (procurement of health, and procurement for health) and concludes what it is in procurement that health justice is transformed into. In order to answer the core research question, the study analyses harmonised transnational EU legislation, policy, case law of the CJEU, and examples from practice through stages of supply framework - at input, output and outcome. The study leads to a conclusion that procurement serves as a tool of governance in health. In order to reach effectiveness and efficiency of procurement in health, it is submitted that procurement needs to reflect on the argument of ethics and economics of health. Health inequalities are an operationalized factor to reach this. The EU procurement law enables to consider health justice. However, it is restricted by the requirement of proportionality. Therefore, health justice is perceived as distortion, rather than a goal of competition to be enhanced. Key messages In order to reach effectiveness and efficiency of procurement in health, it is submitted that procurement needs to reflect on argument of ethics and economics of health. The EU procurement law enables to consider health justice. However, it is rather perceived as distortion, than a goal of competition to be enhanced.