The administration of the Nicaraguan Social Security Institute (INSS) has a favoritism scheme, similar to the one that operates within the orbit of the Ministry of Health, with one main difference: if the Minsa has three favorite companies that it chooses to do business with , the INSS only has one: Distribuidora Cruz Azul, according to two sources in the sector, who asked not to reveal their names, for fear of reprisals.
In both cases (that of the Minsa and that of the INSS), the result is that the two entities end up buying more expensive medicines, a surcharge that is paid with money from the public.
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Last week, several sources in the pharmaceutical sector assured CONFIDENTIAL that there is a mechanism designed to favor three companies to the detriment of private sector companies that must compete in inferior conditions, when that Ministry calls for a tender.
“There is a hodgepodge of reasons, which lead to violation of procedures, which can be on purpose, by emergency, by favoritism, etc. We do not know, and it is difficult to get to the bottom of all this, because they handle everything in a very hermetic way, “said at the time, a source from the pharmaceutical industry.
Responding to the characteristics of a closed and self-sufficient system such as the INSS, private companies that provide medicines to Social Security, have to overcome their own obstacle course to be able to fill an order through the Cruz Azul Distributor, which is It thus becomes a single intermediary, whose main function is to buy medicines from these companies … to resell them to the INSS, with their respective profit margin.
“The INSS does not do tenders, although it should do them, as dictated by the State Procurement Law,” he told CONFIDENTIAL, one of the sources who prefers not to identify himself, to avoid being prevented from providing medicines again, or being indefinitely delayed, the payment of old bills.
It is estimated that, until a few years ago, in the country there were several dozen (up to sixty of them, according to some sources) of Health Service Provider Institutions (IPSS), from which the INSS was closing or buying, not always in the same way. friendly, until the remainder that still makes up the Chamber of Social Security Companies (Cansalud).
“We have only been about eight companies: the [Hospital] Bautista, Salud Integral, Monte España, and El Militar, in Managua, and several others in the departments, ”explained Ismael Reyes, president of that chamber.
The rest of the companies, (and most of the affiliates), were absorbed by the INSS, which began to serve them directly, whether it is to offer them advice and medical care, or to give them the medicines they need.
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Out of many, they went to just one
Until before that ‘great concentration’, each Social Security Company (EMP, as they were called then), acquired the medicines that it would deliver to its patients, buying them from the highest bidder, from among the providers that populated that ecosystem.
As more and more members of the companies that were being absorbed came to be served by the INSS, the Institute increased the purchases of medicines, with one characteristic: if before there were many suppliers to choose from – which usually It guarantees that better prices are obtained- this time, purchases were concentrated in a single –and lucky- supplier: Distribuidora Cruz Azul.
After the INSS bought all the hospitals it could, the absorbed companies became supplied “exclusively” by that company, apparently with mixed capital, partially owned by the same Institute, and some owners private, which sources identify as relatives to the regime, or simply figureheads, according to the testimony of one of the interviewees.
Over time, that company became its sole supplier, in such a way that if any of the private companies that is still operating wants to sell medicines to the absorbed companies, they can do so, but through Distribuidora Cruz Azul, which “ it easily increases the cost of medicines by 20%, but nothing prevents them from raising the cost of 30%, 40% or 50%, because no one is going to complain or say anything, “said the sources.
“If this company were only a purchasing department of the INSS it would be fine, (because it would operate within the large administrative budget of the Institution, and in theory, it would be concerned with achieving the highest possible efficiency in terms of prices), but this is a company that has its own margin, and is charged by the cost of distribution ”, they specified.
Additionally, if Distribuidora Cruz Azul is late with the payment to one of the companies that provides the medicines that it ends up reselling to the INSS, and for that reason, that company is late in the delivery of the new batches of medicines, the The result is that the entire population served by the absorbed IPSS “remains unsupplied, because the system got stuck. If there were no such exclusive distributor, the IPSS could buy each one on their own ”, they refer.
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