Evidence-related requirements in Swedish public sector procurement of health and welfare technologies – a systematic review

Abstract

Background Health and welfare technologies (HWT) are becoming increasingly employed in the Nordic countries, and in Sweden in particular. The amount of HWT public procurement is likely increasing at a similar rate, but requirements for evidence for effectiveness placed on bidders during this process may be lacking. Method This study investigated the use of evidence as a requirement in public sector tendering process of HWT, and how it affected bidder attributes and procurement outcomes. A novel type of systematic review and content analysis of requests for tenders for HWT announced prior to June 2021 was therefore conducted in Swedish public procurement databases. Result Ninety requests for tenders for 11 types of HWT met the inclusion criteria for review, accounting for potential contracts worth 246 to 296 million EUR. Criteria requiring evidence for effectiveness were used in 16 requests for tenders, accounting for 183 million EUR in potential contracts. Eight of the requests referred to an established independent standard to confirm such evidence, such as CE standard of conformity, MDR and/or MDD. This prevalence appears to cut across all types of procuring organisations and all types of HWT. The use of any evidence criteria, or lack thereof, does not appear to affect the outcomes of the tendering process. Conclusion Criteria requiring evidence for effectiveness are used in less than a fifth of all public procurements of health- and welfare technologies in Sweden, and less than 10% refer to some form of independent standard as confirmation of such evidence. The procurement process therefore risks creating a legacy of sub-optimal technologies in health- and social care services. More prevalent and specific requirements for evidence and its continual generation in the procurement process are highly recommended. Recommendations for decision makers, procurement managers, and developers are provided.

Identification of health-related problems in youth: a mixed methods feasibility study evaluating the Youth Health Report System

“…Although developing and using HWT in healthcare is in line with the Swedish vision of becoming world-leading in digitalization and HWT [ 18 ], before the intervention questionnaire could be implemented at YHCs, an effectiveness study [ 24 ] in the right healthcare context [ 23 ] was needed. A potential contextual finding herein was that YHC healthcare professionals found the case report information more beneficial for midwives than for psychologists and counsellors.…”

“…HWT in the form of digital surveys can be effective to illuminate psychosocial issues [ 22 ]. Despite foundational needs for evidence testing of effectiveness for use of HWT [ 23 ], in the healthcare setting the evidence of effectiveness of HWT is often missing [ 24 ]. Thus, this third study in a participatory research project attempts to explore evidence for feasibility of a HWT in the setting of youth health clinics (YHC).…”

Understanding public procurement within the health sector: a priority in a post-COVID-19 world

“…Moreover, even when such information is available it seems that it is rarely used. A recent Swedish study of procurement of health and welfare technologies found that relevant evidence was used in under a fifth of tenders (Richardson et al, 2022).…”

“…Thus, costs can include those over the entire life cycle of what is being procured (Kirkham et al, 2002;Stevanovic et al, 2019). Quality can, among others, be assessed in terms of technical aspects of the product, expertise of the staff performing the contract or after-sales service (Risso-Gill et al, 2014;Rhode, 2019;Zozaya González et al, 2020). However this flexibility has implications; those engaged in procurement must have a detailed knowledge of the need that is to be addressed and what, among many possible trade-offs, is the best solution.…”

Digitalization, stress, and social worker–client relationships during the COVID-19 pandemic

“…Also, there are few studies exploring how various factors (e.g., gender, age, work tasks, employment, and size of the municipality) may explain the impact on the social worker–client relationship, which is something that this article contributes. Since the goal of digital interventions is often “maintaining or promoting health, wellbeing, quality of life and/or increasing efficiency in the operational delivery of welfare, social and health care services, while improving working conditions of the staff” (Richardson et al, 2022, p. 1), this article will focus both on the social worker–client relationship and on social workers’ stress levels. As has already been discussed, social workers’ stress levels can impact the relationship and the outcome of digital interventions.…”