DELIVERING THE CIRCULAR ECONOMY A TOOLKIT FOR POLICYMAKERS

DELIVERING THE CIRCULAR ECONOMY – A TOOLKIT FOR POLICYMAKERS • 143
save EUR 70–90 (10–15) million annually. 283 These findings give a directional view of
the magnitude of this opportunity for Denmark. They rely by necessity on a number of
assumptions, the most important of which are detailed in Appendix B. The estimate has
not included more ‘generic’ products, such as lighting, flooring or printers.
BARRIERS AND POTENTIAL POLICY OPTIONS
The following paragraphs provide an initial perspective on the barriers limiting the
‘performance models in hospital procurement’ opportunity (see Section 2.2.4 for the
barriers framework). Sector experts from both suppliers and hospitals have noted
that the critical barrier to hospitals increasing their use of performance models is
that hospital procurement staff are not trained and have limited experience of other
forms of tenders such as performance contracts or assessing offerings based on
total cost of ownership (TCO) – as well as limited time to change practices. Another
social factor mentioned in interviews is the customary perception that leasing is often
more expensive than buying and the uneasiness that performance contracts could
allow increased private sector influence in public healthcare. Furthermore, hospital
management and procurement departments in many cases lack information compared
to equipment providers on the economic case for access over ownership. These barriers
combine to provide a powerful force of inertia in procurement departments.
To address these barriers, the following policy options could be further investigated.
These options are the result of an initial assessment of how cost-effectively different
policy options might overcome the identified barriers (see Section 2.3.3):
• Guidelines and targets.
o
o
o
Creating guidelines for regions or hospitals for the procurement of
solutions rather than products, and how to work with target setting on
different levels. International examples may serve as ‘blueprints’, such as
the Philips–Nya Karolinska contract in Sweden. Through an innovative
contract structure, the hospital secures access to a pre-defined level of
functionality rather than the availability of specific equipment. Target
setting also occurs in regional procurement partnerships in Denmark,
e.g. the partnership for green procurement.
Stimulating shared/centralised procurement amongst hospitals
where appropriate, to reap economies of scale and leverage purchasing
power. This could take the shape of a centrally negotiated performancebased
contract across all regional hospitals, e.g. for lighting. The
resulting additional cost savings could further accelerate a large-scale
move towards such access-based contractual models.
Supporting measures to optimise equipment utilisation such as
equipment loan programmes between hospitals could round out the
benefits from reshaping procurement procedures and skillsets.
• Capability building.
o
Developing skillsets for circular economy-oriented procurement,
e.g.
• Training staff in optimal procurement design for access over
ownership (e.g. the hospital could provide specialist training
courses based on a nationally developed curriculum).
283 Based on current procurement volumes. This sector-specific impact does not include indirect effects, e.g. on
supply chains, that are captured in the economy-wide CGE modelling. In addition, the distribution of savings
between hospitals and suppliers has not been modelled. It could be argued that it is skewed towards hospitals
in the short term since suppliers want to create incentives for hospitals to set up performance contracts,
but could equilibrate at a more even split in the long-term as the model gets established and consolidated.