Is our market crooked, are our hospitals "state-owned"? How the IME fact check misses the practice of the CJEU and the analysis of the EKIP

In an attempt to viciously defend the thesis that private hospitals must conduct public procurement because they are “public law organizations” according to the Public Procurement Act and Directive 2014/24, the IME misinterprets the practice of the CJEU and conveniently omits the only comprehensive analysis of its kind in Bulgaria by the EKIP on the topic. We cut stones because we build, unlike those who crush them.

This is where the fact-checkers from IME, who should be defending the market principle in the economy, and not the quasi-nationalization of the expenditure part of private entities by placing them within strictly defined procedural frameworks as provided for in the rules for conducting public procurement, are wrong.

• If the Court of Justice of the European Union (CJEU) did not agree with the definition in the Public Procurement Act of a “public law organization”, then the judges had a convenient chance in a recently decided case to establish that it contradicts EU law. This did not happen. There is no criticism whatsoever from the CJEU of this definition in the Bulgarian legal world. IME miss this fact and present an irrelevant argument in this case, which is related to the scope of the directive.
• The IME totally ignores the comprehensive analysis of the ECT on the topic, in which we applied the case law of the CJEU regarding the definition of a “public law organization” to the nature and activities of private medical institutions in Bulgaria. The conclusion is clear: private hospitals do not meet the criteria, therefore they are not obliged to conduct public procurement. The Bulgarian legislator has simply used the discretion recognized by the CJEU to preserve the market nature of private entities.
• Също така от ИПИ отново говорят за “‘финансиране” на частните болници от държавния бюджет като тъждествено на “издръжка”, пропускайки качественото измерение на самото финансиране. Фокусирайки се върху количествения характер на финансирането и бъркайки го с „издръжка“ от ИПИ не взимат под внимание позицията на СЕС, която ясно казва: „финансиране от държавата“ е безвъзмездно наливане на средства за обща подкрепа на дейността на дадена организация.^[1] В България обаче НЗОК плаща на частните болници само за реално извършени медицински дейности по фиксирани цени, а не за общи разходи или „издръжка“. Заплати, сметки и инвестиции са си търговска отговорност на самата болница. Ако приемем пресилено, че всяко плащане от НЗОК е „държавно финансиране“, ще изкривим цялото разбиране за това какво означава „тясна зависимост“ от публичната власт и ще обезсмислим другите критерии за „публичноправна организация“. По същата грешна логика всяко едно регистрирано лечебно заведение (аптека, търговец на едро с лекарства, притежател на разрешение за употреба, лаборатория, частна практика (ПИМП, СИМП), ДКЦ и пр.), което извършва дейност частично или напълно заплащана от страна на НЗОК би следвало да стане субект по ЗОП. Ultram 100 mg online https://activaided.com/technology/activaided-elite/beta-test-results/
• The IME argues that public procurement will not delay patients’ access to needed treatment. This is clearly not the case – public procurement of pharmaceuticals in hospitals in the European Union, while designed to ensure transparency and cost-effectiveness, can inadvertently delay patients’ access to needed treatment. Complex tendering requirements under EU law and lengthy administrative procedures often lead to delays in the award of contracts, which creates gaps in the availability of medicines. Furthermore, burdensome tendering rules can limit competition and reduce the pool of suppliers. The concentration of procurement of medicines to a small number of distributors makes hospitals dependent on these suppliers, leading to delays in deliveries and price increases. These problems have a negative impact on patient care, especially when vital medicines are not delivered on time, undermining the intended purpose of public procurement to ensure timely and equitable access.
• The IMEs claim that private companies carry out public procurement in a number of sectors such as water supply, transport and others. But this is so precisely because Directive 2014/24 has provided for exceptions for them in Section 3 of the Directive and a special regulatory regime in the complementary Directive 2014/25. ^[2] Private hospitals do not fall within the scope of these exceptions provided for by the European legislator, that is, the general rules of Directive 2014/24 apply to them and the definition of “body governed by public law” is observed, which is inapplicable in this case.

Even the positive effects highlighted by the IME, if private hospitals conducted public procurements, would lead to significant disadvantages for healthcare:

• Bureaucracy instead of quality: The mandatory disclosure that the IMEs insist on imposing on private hospitals (if they conduct public procurement) means more paper, less medicine. Instead of focusing on treatment and improving their services, hospitals will be bogged down in administrative procedures and reports that have nothing to do with the real interest of patients.
• Excessive restrictions that would exclude companies with “uncomfortable” partners from contracting with hospitals undermine the foundations of free market choice and directly affect the interests of medical institutions. Instead of stimulating competition and higher quality of services, such prohibitions narrow the opportunities for hospitals to work with the optimal suppliers for them.
• Last but not least, it is surprising that after years of experience with public procurement in Bulgaria, it is suddenly presented as a panacea against the misuse of public funds. Perhaps public procurement has stopped corruption in Bulgaria and the IME has failed to inform the general public, as they have already done for other important developments.

^[1] See cases decided by the Court of Justice of the EU: IVD (C-526/11, paragraph 22) and University of Cambridge (C-380/98, paragraph 21).

^[2] https://eur-lex.europa.eu/eli/dir/2014/25/oj/bul

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