DISCUSSION ON NEW DEVELOPMENTS IN THE LEGAL FRAMEWORK FOR MEDICAL EQUIPMENT BIDDING IN PUBLIC HEALTHCARE FACILITIES UNDER CURRENT VIETNAMESE LAW

ABSTRACT

New developments in the legal framework for medical equipment bidding, as stipulated in Law on Bidding No. 22/2023/QH15 and its guiding documents, have addressed bottlenecks in the procurement of medical equipment, simplified bidding procedures, clarified procurement authority, defined package prices, and expanded the scope of cases eligible for direct appointment. These changes not only facilitate public healthcare facilities in medical equipment procurement, ensuring the selection of higher quality and more cost-effective equipment while meeting specialized needs, but also contribute to improving the quality of medical examination, treatment, and healthcare services.

АННОТАЦИЯ

Новые изменения в правовой базе проведения торгов медицинским оборудованием, предусмотренные Законом о торгах № 22/2023/QH15 и директивными документами к нему, устранили уязвимые места в закупках медицинского оборудования, упростили процедуры торгов, уточнили полномочия по закупкам, определили цены на пакеты услуг и установили ряд случаев, которые могут быть решены напрямую. Эти изменения не только облегчают государственным учреждениям здравоохранения закупку, обеспечивая выбор более качественного и экономичного оборудования для удовлетворения специализированных потребностей, но и способствуют повышению качества медицинского обследования, лечения и медицинских услуг.

Keywords: Law on Bidding No. 22/2023/QH15, medical equipment procurement, public healthcare facilities.

Ключевые слова: Закон о торгах № 22/2023/QH15, закупка медицинского оборудования, государственные учреждения здравоохранения.

Alongside the healthcare workforce, medical equipment is a critical factor determining the accuracy, speed, efficiency, and safety in patient examination, diagnosis, and treatment. It plays a vital role in supporting the mission of caring for and protecting public health at healthcare facilities. Therefore, investing in the procurement of medical equipment is always a top priority for these facilities. However, acquiring modern, high-quality, specialized, and compatible equipment that meets the specific professional requirements of each healthcare facility while ensuring economic efficiency remains a challenging task for healthcare managers and policymakers.

Since the enactment of the Bidding Law No. 61/2005/QH11, and later the Bidding Law No. 43/2013/QH13, which came into effect on July 1, 2014, the procurement of goods, in general, has become more flexible. The bidding process has been adjusted to better align with the rapidly developing market economy and global integration, in line with the policies of the Party and the State. The procurement of medical equipment in public healthcare facilities has also been governed by the Bidding Law, which aims to select contractors for the supply and installation of specialized medical equipment using state budget funds, as stipulated by the State Budget Law, and legitimate revenue sources as per the law for public sector units.

In essence, bidding is merely a tool or means. The purpose of bidding is to select high-quality products at reasonable prices, achieving economic efficiency. The Bidding Law of 2005 and its 2013 amendment have approached basic international practices, received high evaluations, and achieved positive results when implemented. However, the 2013 Bidding Law has now revealed several practical issues that need revision. In recent years, the procurement of medical equipment has witnessed numerous negative incidents, significantly affecting the public's perception of healthcare professionals. Unlike other goods, medical equipment is considered a specialized item, but under the 2013 Bidding Law, it was subject to the same bidding procedures as ordinary goods.

To address this issue, during the drafting process of the amended Bidding Law of 2023, the procurement of goods and services in the healthcare sector has consistently been a "hot" topic of discussion among National Assembly members. Therefore, when the Bidding Law No. 22/2023 was passed by the 15th National Assembly, consisting of 10 Chapters and 96 Articles, and effective from January 1, 2024, Chapter V was specifically allocated to regulate matters of centralized procurement; procurement of drugs, chemicals, testing materials, and medical equipment; and the provision of public products and services.

The amended Bidding Law of 2023, Decree No. 24/2024/ND-CP dated February 27, 2024, by the Government (Decree 24/2024/ND-CP), and the accompanying guiding legal documents have brought significant changes compared to the 2013 version. These amendments continue to refine and balance the State's interests, facilitate the project owners in organizing the selection of contractors, while still ensuring strict management to prevent exploitation, misconduct, and corruption. Notably, many new points in the legal framework have resolved obstacles in the procurement of medical equipment. These changes aim to enhance transparency, competition, and efficiency in the process of selecting contractors to supply and install medical equipment, thereby contributing to the improvement of healthcare service quality.

1. Selection of Contractors for Supplying Testing Materials, Chemicals, and Medical Equipment

Currently, most testing machines (immunology, microbiology, hematology, biochemistry) are new generation, closed systems (under placement or loan arrangements). These machines and equipment are designed to use only the specific chemicals from the manufacturer that provided the machine; using chemicals from other manufacturers would result in inaccurate or incomplete test results. Moreover, the cost of investing in a testing system is relatively high, but these machines quickly become outdated and obsolete, and are soon discarded as they no longer meet the required standards. Therefore, whether purchasing or renting the machines, medical facilities become more dependent on the suppliers of chemicals and materials, even if these suppliers have a monopoly and might increase prices or impose terms, as it is not possible to choose another contractor for chemicals and materials to be used with the existing machines.

Compared to the Bidding Law of 2013, the Bidding Law of 2023 has provided a more comprehensive legal framework for purchasing chemicals and medical equipment. Article 55 of the Bidding Law of 2023 clearly outlines distinct methods for selecting contractors to supply testing materials, chemicals, and medical equipment; it also specifies the transfer of ownership and usage rights for medical equipment in specific cases, instead of the general provisions under the Bidding Law of 2013. Accordingly, public healthcare facilities can select the provision of chemicals, testing materials, and medical equipment through one of the following methods:

- Selecting a contractor to execute the bidding package for supplying chemicals, testing materials, with the winning contractor responsible for providing the medical equipment required to use these chemicals and testing materials as per the project owner's requirements; the contractor does not transfer ownership, only the usage rights of the medical equipment to the healthcare facility.

This is a comprehensive procurement model that includes the supply of chemicals, testing materials, medical equipment, replacement parts, accessories, and related services to operate the medical equipment, such as maintenance and repair, as well as the right to use the medical equipment for a specified period. In this model, the winning contractor is responsible for providing the medical equipment necessary to use the chemicals and testing materials as required by the project owner. However, the contractor does not transfer ownership of the medical equipment, only the right to use it to the healthcare facility.

- Selecting a Contractor Based on the Number of Technical Services: The contractor provides the project owner with chemicals, testing materials, medical equipment, replacement parts, accessories, and related services to operate the medical equipment based on the number of technical services required by the project owner or the inviting party as specified in the bidding documents or request for proposal documents, without providing personnel to operate the medical equipment.

In this method, the contractor only transfers the right to use, not ownership of the medical equipment, to the project owner. The bidding package price and the bid price are determined based on the estimated number of technical services. The contract duration is not to exceed five years.

To select a contractor to provide a comprehensive package of equipment, chemicals, testing materials, and accompanying services (excluding operational personnel) under this regulation, Clause 1, Article 93 of Decree No. 24/2024/ND-CP stipulates that the bidding documents must include technical requirements for the equipment, operating software, and equipment calibration; the shelf life requirements for chemicals and testing materials; a list of all chemicals, testing materials, and necessary supplies to carry out each technical service; packaging specifications for these goods; requirements for storage, warehousing of chemicals, and testing materials, installation, quality testing, and service parameters, as well as warranty and maintenance requirements during the contract implementation; and backup replacement equipment.

- Selecting a Contractor to Execute the Bidding Package for Supplying Medical Equipment, Chemicals, and Testing Materials. The contractor transfers ownership of the medical equipment, chemicals, and testing materials to the project owner from the moment the contract between the parties takes effect.

- Selecting a Contractor to Supply Medical Equipment According to the Bidding Law.

This regulation is similar to the procurement of other ordinary goods. The project owner organizes the selection of a contractor to supply and install medical machinery and equipment in accordance with the bidding laws for goods procurement. This ensures fairness, transparency, and efficiency in selecting contractors that supply high-quality medical equipment, meeting the professional requirements of healthcare activities in medical facilities.

- Selecting a Contractor to Supply Chemicals and Testing Materials to Operate Existing Medical Equipment.

In this method, to operate existing medical equipment, the healthcare facility may select a contractor to supply the necessary chemicals and testing materials. The contractor selection process must comply with bidding regulations and ensure suitability and fulfillment of technical and quality requirements.

- Selecting a Contractor to Provide Technical Services According to Healthcare Law. The provider of technical services to healthcare facilities will comply with the regulations of the Law on Medical Examination and Treatment. This ensures that the technical services meet the precise, safe medical standards and procedures, contributing to the improvement of healthcare quality and patient treatment.

2. Direct appointment for Medical Equipment Procurement in Urgent Situations

While the Bidding Law of 2013 only allowed direct appointment for packages involving the purchase of drugs, chemicals, materials, and medical equipment to implement disease prevention and control efforts in urgent situations, Point c, Clause 1, Article 23 of the Bidding Law No. 22/2023 has expanded and adjusted the cases in which direct appointmentcan be applied to emergency packages, such as:

- Packages involving the provision of consulting services, non-consulting services, drugs, chemicals, testing materials, medical equipment, components, accessories, vehicles, and construction work that need to be immediately implemented to serve disease prevention and control efforts or to maintain the operation of medical facilities in urgent situations, avoiding harm to the lives and health of the public;

- Packages for the purchase of drugs, chemicals, testing materials, medical equipment, components, and accessories to provide emergency care to patients in critical condition, as stipulated by the Law on Medical Examination and Treatment, in cases where the medical facility lacks sufficient drugs, chemicals, testing materials, medical equipment, components, and accessories;

- Packages for the purchase of drugs or medical equipment that are exclusively produced by a single manufacturer in the market.

The direct appointment of packages specified in Point c, Clause 1, Article 23 mentioned above, applicable to the procurement of medical equipment, is to be carried out in the following cases:

a. In urgent situations that require immediate implementation to serve disease prevention and control efforts:

 (i) Packages involving consulting services, non-consulting services, drugs (including vaccines and biological products), chemicals, testing materials, medical equipment (including vaccination materials), components, accessories, vehicles, and construction work that need to be immediately implemented to serve disease prevention and control efforts, as per the directive documents from the competent authorities (government healthcare management agencies or local governments) or a decision to declare an epidemic for an infectious disease, or a local request to declare an epidemic for a Group A infectious disease as defined by law;

(ii) Packages involving consulting services, non-consulting services, drugs, chemicals, testing materials, medical equipment, components, accessories, vehicles, and construction work to establish, renovate, or build treatment areas or field hospitals to support disease prevention and control efforts, where the current supply of drugs, chemicals, testing materials, medical equipment, components, accessories, and vehicles at the medical facility is insufficient.

(iii) Packages involving consulting services, non-consulting services, drugs, chemicals, testing materials, medical equipment, components, accessories, vehicles, and construction work to support diplomatic missions or assist other countries in disease prevention and control efforts, which need to be immediately implemented to meet practical demands and at the request of competent authorities;

b. In urgent situations that require immediate action to maintain the operation of a healthcare facility.

This includes packages involving consulting services, non-consulting services, drugs, chemicals, testing materials, medical equipment, components, accessories, vehicles, and construction work, where failure to implement them immediately would disrupt the operations of the healthcare facility, potentially endangering the health and lives of patients;

c. In emergency situations where patients are in critical condition as defined by the Law on Medical Examination and Treatment (if applicable). This includes packages involving consulting services, non-consulting services, drugs, chemicals, testing materials, medical equipment, components, accessories, vehicles, and construction work that are urgently needed, where no substitutes are available, and where they must be used to ensure the health and lives of patients;

d. Other cases as guided by the Ministry of Health (if applicable).

Previously, the selection of contractors for supplying drugs and medical equipment, whether in urgent situations or not, required going through bidding procedures as prescribed, which took a significant amount of time to select a contractor with sufficient capacity and experience. Therefore, the Bidding Law of 2023’s provision allowing direct appointment for the procurement of drugs and medical equipment in urgent cases is intended to facilitate the procurement of drugs and medical equipment that have specific characteristics, in line with the specialized activities of the healthcare sector. This is one of the timely and effective additions in the Bidding Law of 2023, which helps to minimize the loss of life and health of the public.

3. Decentralization of Decision-Making Authority for Applying Contractor Selection Methods in Special Cases

The Bidding Law of 2013 stipulated that the Prime Minister was the sole authority responsible for reviewing and deciding on contractor selection plans in all special cases. However, the Bidding Law of 2023 has revised this regulation to delegate authority to other bodies alongside the Prime Minister in managing the application of contractor selection methods in special cases. Specifically, the Minister of Health is authorized to decide on contractor selection for packages involving the procurement of drugs, vaccines, and medical equipment through international organizations.

To ensure appropriateness in the procurement of assets, goods, and services to support the activities and tasks assigned, Decision No. 921/QĐ-BYT dated April 11, 2024 [4], stipulates the authority to make procurement decisions for assets, goods, and services for the operations of budgetary units under and affiliated with the Ministry of Health. This includes program, project, and non-project assistance from foreign donors, the management boards of programs and projects funded by foreign donors managed by the Ministry of Health, and non-budgetary state financial funds under or affiliated with the Ministry of Health (except for certain cases as stipulated in Article 1 of Decision No. 921/QĐ-BYT). This creates favorable conditions for units to carry out procurement activities in accordance with the authority assigned to them and in compliance with legal regulations.

4. Price Negotiation for Packages Involving Drugs, Medical Equipment, and Testing Materials with Only One or Two Manufacturers

The Bidding Law of 2013 (Clause 2, Article 48) only stipulated that price negotiation was applicable for drug procurement packages where there were only one or two manufacturers, for original brand-name drugs, rare drugs, drugs still under patent, and other special cases. Article 28 of the Bidding Law of 2023 has supplemented and adjusted the circumstances under which price negotiation can be applied, extending it to medical equipment and testing materials with only one or two manufacturers, while removing the cases of rare drugs, drugs still under patent, and other special cases. The Minister of Health is authorized to decide on the application of price negotiation and to issue the list of drugs, medical equipment, and testing materials subject to price negotiation, along with the regulations on the procedures for selecting contractors for packages that apply price negotiation.

Specifically, on May 14, 2024, the Ministry of Health issued Circular No. 05/2024/TT-BYT, which stipulates the list of drugs, medical equipment, and testing materials eligible for price negotiation and the procedures for selecting contractors for packages that apply price negotiation, replacing Chapter V of Circular No. 15/2019/TT-BYT dated July 11, 2019 [1], which regulated drug bidding at public healthcare facilities. In addition to issuing the list of drugs, testing materials, and medical equipment eligible for price negotiation, Circular 05/2024 adds several provisions to concretize the new regulations related to "price negotiation" under the Bidding Law of 2023 as applied in the healthcare sector. These provisions took effect from May 15, 2024. Accordingly, beyond selecting contractors, healthcare facilities are now also able to engage in price negotiations.

The regulations in Circular 05/2024 provide detailed, specific, and flexible guidance on the price negotiation process, designed to meet the operational needs of the healthcare sector and prevent the shortages of drugs and medical equipment that occurred in the past.

a. Regulations on Medical Equipment and Testing Materials Included in the Price Negotiation List

Circular 05/2024 clearly states that medical equipment and testing materials included in the price negotiation list must meet the following principles and criteria:

- The medical equipment and testing materials must be legally marketed in Vietnam;

- The medical equipment and testing materials must have only one or two manufacturers based on their principle, technology, or intended use.

Accordingly, the list of medical equipment subject to price negotiation includes four types: Photon-counting CT systems, Robotic systems for laparoscopic surgery, Systems for neurosurgery using planning technology and precise robotic assistance (Rosa Brain), and Systems for hip and knee replacement surgery (using planning technology and precise robotic assistance).

b. Changes in the Authority Responsible for Leading and Organizing Price Negotiations

Previously, Circular 15/2019 stipulated that the authority responsible for leading and organizing price negotiations (including tasks such as developing negotiation plans; drafting, appraising, and approving request dossiers; developing and approving price negotiation plans; and directly negotiating prices) belonged to the Drug Price Negotiation Council, established by the Minister of Health, with the Council's Chairman being a leader from the Ministry of Health and the Drug Price Negotiation Council's standing unit being the National Drug Centralized Procurement Center.

Circular 05/2024 [3] adjusts the above authority to the price negotiation unit (which is assigned to carry out the task) and the Inter-sectoral Price Negotiation Team (established by the Minister of Health), which includes representatives from the price negotiation unit, the Ministry of Finance, Vietnam Social Security, representatives from relevant departments of the Ministry of Health, and experts (when necessary). This regulation aims to ensure that the organization and implementation of price negotiations are more specialized and better suited to the specific conditions of each price negotiation unit.

c. Price Negotiations Conducted According to Annual Plans

Compared to Circular 15/2019, Circular 05/2024 establishes stricter and more specific regulations, requiring that price negotiations must be based on an organized price negotiation plan. This plan must clearly identify the following minimum contents:

(i) The number of price negotiation sessions to be conducted during the year;

(ii) The list of drugs and medical equipment to be negotiated at each session;

(iii) The expected timeframe for conducting price negotiations.

In addition to requiring price negotiations to be organized according to a plan, Circular 05/2024 also provides a "flexible" mechanism to organize bidding, helping to avoid a "passive" situation in the bidding process, including:

(i) For drugs and medical equipment in the list subject to price negotiations that have already published negotiation results, the next round of price negotiations can proceed with planning, determining procurement needs, and organizing the selection of contractors.

(ii) Units and localities are allowed to proactively organize the selection of contractors to supply drugs and medical equipment under price negotiation by other methods (not limited to price negotiation), such as open bidding, restricted bidding, direct contracting, and direct procurement. This can be done based on notifications from the Price Negotiation Unit in special cases such as when drugs, medical equipment, or testing materials in the price negotiation list do not meet the principles and criteria for organizing price negotiations; when the price negotiation process is not timely; when it is impossible to regulate drugs or medical equipment; or when price negotiations are unsuccessful, etc.

d. Detailed Regulations on Price Negotiation Processes

Overall, the bidding process under Circular 05/2024 includes steps similar to those inherited from Circular 15/2019, with the following basic steps:

- Step 1: Identify and consolidate procurement needs;

- Step 2: Prepare and appraise the contractor selection plan;

- Step 3: Prepare, appraise, and approve the request dossier;

- Step 4: Issue the invitation for proposals and receive proposal dossiers;

- Step 5: Evaluate proposal dossiers and prepare a price negotiation plan;

- Step 6: Conduct price negotiations and make decisions;

- Step 7: Appraise, approve the results of price negotiations, and organize implementation.

However, Circular 05/2024 supplements many detailed and specific regulations related to each issue of each step mentioned above following strict principles. Accordingly:

- Clearly defines and specifies the roles, powers, and responsibilities of each relevant agency in consolidating procurement needs; preparing and appraising the contractor selection plan (including the unit responsible for determining procurement needs, the lead unit consolidating procurement needs, Vietnam Social Security, etc.).

- Clearly stipulates that the formulation of the price negotiation plan for medical equipment, etc., must be based on one or several or all of the following information:

+ The winning bid price of the negotiated medical equipment (if any);

+ The duration of circulation in Vietnam;

+ Information on the value of the negotiated medical equipment that has been used, provided by Vietnam Social Security (if any);

+ The planned value and quantity of the negotiated medical equipment;

+ Reference prices of the negotiated medical equipment in ASEAN countries (if any). If there are no reference prices in ASEAN, reference may be made to other countries (if any);

+ The contractor's proposal dossier, the evaluation report of the proposal dossier, and the consolidated information on the negotiated medical equipment provided by the expert team;

+ Other relevant information (if any).

- Clearly stipulates the implementation of price negotiations with the contractor according to specific principles.

The desired negotiated price is the price used for negotiation and is not necessarily the price that must be achieved during the negotiation process. In cases where the contractor proposes a price higher than the desired price, the inter-agency team suggests the contractor review and adjust the proposed price, with a maximum of three reviews allowed. The regulations of Circular 05/2024 aim to strictly control the price negotiation process, preventing negative outcomes in price negotiations.

e. Flexible provisions in bidding activities

The subject of price negotiation is for "special" types of drugs and medical equipment. If, unfortunately, there is a shortage of these drugs or medical equipment and there is no timely replenishment due to rigid mechanisms and procedures, it will create many negative consequences. Accordingly, Circular 05/2024, while tightening price negotiation regulations to prevent negativity, also creates "flexible" mechanisms but still under control and within the "framework" to support the resolution of drug and medical equipment shortages if they occur, specifically:

- At the time of signing the contract, the healthcare facility and the contractor may agree to adjust the quantity up or down compared to the quantity in the signed contract based on the provisions in the request for proposal.

- Allowing the adjustment of drugs, medical equipment. Accordingly, the adjustment of winning drugs, medical equipment, and test supplies includes purchasing additional within the optional purchase scope and transferring between healthcare facilities.

- At the time of signing the contract, the healthcare facility and the contractor may agree to adjust the quantity up or down compared to the quantity in the signed contract based on the provisions in the request for proposal.

- Allowing the adjustment of drugs, medical equipment. Accordingly, the adjustment of winning drugs, medical equipment, and test supplies includes purchasing additional within the optional purchase scope and transferring between healthcare facilities.

5. Other notable points

Previously, regulations mandated the reference of at least three quotations when determining the package price for procuring medical equipment, supplies, and replacement parts. However, for certain large medical equipment manufacturers in the market, the equipment and components of each manufacturer are specific to their machines and cannot be replaced with parts or equipment from other manufacturers. Therefore, for a component or supply of a device or system that is damaged, it can only be purchased from the original equipment manufacturer, and only one quotation is provided. In the absence of three quotations and other required reference documents, there is no provision granting the Investor the authority to determine the package price. If a purchase is made intentionally to ensure that the equipment can operate and meet the examination and treatment needs of the healthcare facility, it could be considered intentional direct appointment, which does not ensure fairness and transparency as required. Additionally, the regulation limiting the selection of a contractor to a maximum of 90 days poses significant challenges for public healthcare facilities.

To address these challenges, Decree No. 24/2024/ND-CP (Clause d, Article 16) stipulates that collecting at least one quotation for goods and services, and encouraging the collection of more than one quotation, is one of the seven bases for determining the package price. Specifically for the medical field, in cases where there is more than one quotation, the Investor is allowed to select the highest quotation that aligns with the financial capacity and professional requirements to set the package price. The Investor is responsible for collecting quotations to ensure transparency and publicity. The supplier providing the quotation is responsible for providing information on the price of goods and services that is commensurate with their supply capacity and must ensure that the provision of quotations does not violate the provisions of law on competition, dumping, or price gouging [5].

Circular 14/2023/TT-BYT [2] has introduced greater flexibility in the procurement process for medical equipment. In particular, the Circular allows medical facilities to directly request quotations in special cases, such as when there is a limited supply of suppliers or when technological compatibility is crucial.

The Circular outlines various methods for determining package prices, with a preference for collecting quotations. However, it also acknowledges the need for flexibility in special circumstances, such as when only one valid quotation is available or when ensuring equipment compatibility is essential. In such cases, the investor may select the highest quotation that meets the financial and technical requirements.

By streamlining procedures and providing more flexibility, Circular 14/2023 aims to facilitate the procurement of medical equipment, ensuring a more transparent and efficient process for healthcare facilities.

To accommodate the specific procurement needs of healthcare facilities, particularly those in remote areas with limited staff, Decree No. 24/2024/ND-CP also stipulates that if the Investor does not have personnel who meet the requirements of having a professional certification in procurement, a university degree, and at least three years of experience in a related field, or if the Investor cannot select a consulting firm to form an expert panel or evaluation panel, the Investor has the authority to mobilize and assign tasks to medical doctors, pharmacists, or management staff, or invite officials from the Department of Health, Ministry of Health, and medical experts to participate in the expert panel or evaluation panel without having to meet the requirements for personnel as members of the expert panel or evaluation panel.

The 2023 Bidding Law also specifically stipulates cases where agencies, organizations, and enterprises can independently decide on the selection of bidders, ensuring transparency, efficiency, and accountability, in certain cases without the need for a bidding process; allowing the tender documents to specify the origin of goods to select high-quality goods; and applying the option to purchase additional goods without the need for a bidding process.

Procurement of medical equipment is a perennial issue that has always been a hot topic of discussion and public concern. Although the revised Bidding Law has established a modern and comprehensive legal framework, its implementation still faces numerous challenges, especially in healthcare facilities in remote areas.

One of the main reasons is the limited capacity of the staff responsible for procurement. The combination of multiple responsibilities and a lack of systematic training has led to delays in updating legal regulations and a lack of experience in the implementation process.

To overcome these limitations, a comprehensive set of solutions is needed, including:

- Enhancing staff capacity: Organizing specialized training courses on bidding, developing online training programs, and facilitating staff participation in professional forums and workshops.

- Support from management agencies: Providing support tools such as bidding management software, standard document templates, and building supplier databases.

- Monitoring and evaluation mechanisms: Regularly monitoring and evaluating the bidding process, establishing reward mechanisms, and handling violations.

Improving the legal framework and enhancing the capacity of staff are crucial factors in ensuring that the procurement process for medical equipment is conducted in a transparent, efficient, and effective manner, thereby contributing to improving the quality of healthcare services and protecting the rights of patients.

References:

1. Ministry of Health. (2019, July 11). Circular No. 15/2019/TT-BYT providing guidance on bidding for supply of drugs for public health facilities.
2. Ministry of Health. (2023, June 30). Circular No. 14/2023/TT-BYT stipulating the process and procedure for building bidding package prices for procurement of goods and services in the field of medical devices at public health facilities.  
3. Ministry of Health. (2024, May 14). Circular 05/2024/TT-BYT regulating the list of drugs, medical devices, and testing supplies eligible for price negotiation and the process and procedures for selecting contractors for bidding packages and applying for price negotiation.
4. Ministry of Health. (2024, April 11). Decision 921/QD-BYT regulating the authority to decide on the procurement of assets, goods, and services for the activities of agencies and units under the Ministry of Health of Vietnam.
5. Phương Anh. (2023).Solving problems related to medical equipment procurement and bidding for hospitals. Inspectorate Newspaper. /[Electronic resource] - Access mode. - URL:https://thanhtra.com.vn/kinh-te/dau-tu/go-kho-trong-dau-thau-mua-sam-trang-thiet-bi-y-te-cho-cac-benh-vien-214566.html(Accessed: 13.07.2024).