Outcome-based reimbursement in Central-Eastern Europe and Middle-East
Outcome-based reimbursement models can effectively reduce the financial risk to health care payers in cases when there is important uncertainty or heterogeneity regarding the clinical value of health technologies. Still, health care payers in lower income countries rely mainly on financial based agr...
| Main Authors: | , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-09-01
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| Series: | Frontiers in Medicine |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2022.940886/full |
| _version_ | 1811265759872024576 |
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| author | Ildikó Ádám Marcelien Callenbach Bertalan Németh Rick A. Vreman Rick A. Vreman Cecilia Tollin Johan Pontén Dalia Dawoud Dalia Dawoud Jamie Elvidge Nick Crabb Sahar Barjesteh van Waalwijk van Doorn-Khosrovani Anke Pisters-van Roy Áron Vincziczki Emad Almomani Maja Vajagic Z. Gulsen Oner Mirna Matni Jurij Fürst Rabia Kahveci Wim G. Goettsch Wim G. Goettsch Zoltán Kaló Zoltán Kaló |
| author_facet | Ildikó Ádám Marcelien Callenbach Bertalan Németh Rick A. Vreman Rick A. Vreman Cecilia Tollin Johan Pontén Dalia Dawoud Dalia Dawoud Jamie Elvidge Nick Crabb Sahar Barjesteh van Waalwijk van Doorn-Khosrovani Anke Pisters-van Roy Áron Vincziczki Emad Almomani Maja Vajagic Z. Gulsen Oner Mirna Matni Jurij Fürst Rabia Kahveci Wim G. Goettsch Wim G. Goettsch Zoltán Kaló Zoltán Kaló |
| author_sort | Ildikó Ádám |
| collection | DOAJ |
| description | Outcome-based reimbursement models can effectively reduce the financial risk to health care payers in cases when there is important uncertainty or heterogeneity regarding the clinical value of health technologies. Still, health care payers in lower income countries rely mainly on financial based agreements to manage uncertainties associated with new therapies. We performed a survey, an exploratory literature review and an iterative brainstorming in parallel about potential barriers and solutions to outcome-based agreements in Central and Eastern Europe (CEE) and in the Middle East (ME). A draft list of recommendations deriving from these steps was validated in a follow-up workshop with payer experts from these regions. 20 different barriers were identified in five groups, including transaction costs and administrative burden, measurement issues, information technology and data infrastructure, governance, and perverse policy outcomes. Though implementing outcome-based reimbursement models is challenging, especially in lower income countries, those challenges can be mitigated by conducting pilot agreements and preparing for predictable barriers. Our guidance paper provides an initial step in this process. The generalizability of our recommendations can be improved by monitoring experiences from pilot reimbursement models in CEE and ME countries and continuing the multistakeholder dialogue at national levels. |
| first_indexed | 2024-04-12T20:29:42Z |
| format | Article |
| id | doaj.art-cad946d469d047ba9bcf6c3dcb92c059 |
| institution | Directory Open Access Journal |
| issn | 2296-858X |
| language | English |
| last_indexed | 2024-04-12T20:29:42Z |
| publishDate | 2022-09-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Medicine |
| spelling | doaj.art-cad946d469d047ba9bcf6c3dcb92c0592022-12-22T03:17:47ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2022-09-01910.3389/fmed.2022.940886940886Outcome-based reimbursement in Central-Eastern Europe and Middle-EastIldikó Ádám0Marcelien Callenbach1Bertalan Németh2Rick A. Vreman3Rick A. Vreman4Cecilia Tollin5Johan Pontén6Dalia Dawoud7Dalia Dawoud8Jamie Elvidge9Nick Crabb10Sahar Barjesteh van Waalwijk van Doorn-Khosrovani11Anke Pisters-van Roy12Áron Vincziczki13Emad Almomani14Maja Vajagic15Z. Gulsen Oner16Mirna Matni17Jurij Fürst18Rabia Kahveci19Wim G. Goettsch20Wim G. Goettsch21Zoltán Kaló22Zoltán Kaló23Center for Health Technology Assessment, Semmelweis University, Budapest, HungaryDivision of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, NetherlandsSyreon Research Institute, Budapest, HungaryDivision of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, NetherlandsNational Health Care Institute, Zorginstituut Nederland, Diemen, NetherlandsThe Dental and Pharmaceutical Benefits Agency, Tandvårds- och Låkemedelsförmånsverket, Stockholm, SwedenThe Dental and Pharmaceutical Benefits Agency, Tandvårds- och Låkemedelsförmånsverket, Stockholm, SwedenNational Institute for Health and Care Excellence, London, United KingdomFaculty of Pharmacy, Cairo University, Cairo, EgyptNational Institute for Health and Care Excellence, London, United KingdomNational Institute for Health and Care Excellence, London, United KingdomDepartment of Medical Advisory and Innovation, Centraal Ziekenfonds (CZ) Health Insurance, Tilburg, NetherlandsDepartment of Medical Advisory and Innovation, Centraal Ziekenfonds (CZ) Health Insurance, Tilburg, NetherlandsNational Health Insurance Fund of Hungary, Nemzeti Egészségbiztosítási Alapkezelõ, Budapest, Hungary0Department for Health Technology Assessment, Jordanian Royal Medical Services, Amman, Jordan1Croatian Health Insurance Fund, Zagreb, Croatia2Social Security Institution of Turkey, Ankara, Turkey3Social Security Main Office, Caisse Nationale de la Sécurité Sociale, Beirut, Lebanon4Department of Drugs, Health Insurance Institute of Slovenia, Ljubljana, Slovenia5Pharmaceutical Policies and Governance, Management Sciences for Health, Kyiv, UkraineDivision of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, NetherlandsNational Health Care Institute, Zorginstituut Nederland, Diemen, NetherlandsCenter for Health Technology Assessment, Semmelweis University, Budapest, HungarySyreon Research Institute, Budapest, HungaryOutcome-based reimbursement models can effectively reduce the financial risk to health care payers in cases when there is important uncertainty or heterogeneity regarding the clinical value of health technologies. Still, health care payers in lower income countries rely mainly on financial based agreements to manage uncertainties associated with new therapies. We performed a survey, an exploratory literature review and an iterative brainstorming in parallel about potential barriers and solutions to outcome-based agreements in Central and Eastern Europe (CEE) and in the Middle East (ME). A draft list of recommendations deriving from these steps was validated in a follow-up workshop with payer experts from these regions. 20 different barriers were identified in five groups, including transaction costs and administrative burden, measurement issues, information technology and data infrastructure, governance, and perverse policy outcomes. Though implementing outcome-based reimbursement models is challenging, especially in lower income countries, those challenges can be mitigated by conducting pilot agreements and preparing for predictable barriers. Our guidance paper provides an initial step in this process. The generalizability of our recommendations can be improved by monitoring experiences from pilot reimbursement models in CEE and ME countries and continuing the multistakeholder dialogue at national levels.https://www.frontiersin.org/articles/10.3389/fmed.2022.940886/fullmanaged entry agreementreimbursementpricingvalue-based pricinghealth technology assessmentpay-for-performance |
| spellingShingle | Ildikó Ádám Marcelien Callenbach Bertalan Németh Rick A. Vreman Rick A. Vreman Cecilia Tollin Johan Pontén Dalia Dawoud Dalia Dawoud Jamie Elvidge Nick Crabb Sahar Barjesteh van Waalwijk van Doorn-Khosrovani Anke Pisters-van Roy Áron Vincziczki Emad Almomani Maja Vajagic Z. Gulsen Oner Mirna Matni Jurij Fürst Rabia Kahveci Wim G. Goettsch Wim G. Goettsch Zoltán Kaló Zoltán Kaló Outcome-based reimbursement in Central-Eastern Europe and Middle-East Frontiers in Medicine managed entry agreement reimbursement pricing value-based pricing health technology assessment pay-for-performance |
| title | Outcome-based reimbursement in Central-Eastern Europe and Middle-East |
| title_full | Outcome-based reimbursement in Central-Eastern Europe and Middle-East |
| title_fullStr | Outcome-based reimbursement in Central-Eastern Europe and Middle-East |
| title_full_unstemmed | Outcome-based reimbursement in Central-Eastern Europe and Middle-East |
| title_short | Outcome-based reimbursement in Central-Eastern Europe and Middle-East |
| title_sort | outcome based reimbursement in central eastern europe and middle east |
| topic | managed entry agreement reimbursement pricing value-based pricing health technology assessment pay-for-performance |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2022.940886/full |
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