Reimbursement Methods Research Articles

Understanding medicine access strategies for innovator medicines registered in South Africa

BackgroundSouth Africa is composed of a two-tier healthcare system. One tier is a private healthcare system that is funded through medical insurance, and comprised of people who can afford to make monthly payments towards their medical insurance. Second tier is a government-funded public healthcare system, which covers the majority of the population. This study explored the perceived barriers and current strategies being utilised by the pharmaceutical industry to increase access to innovator medicines.ObjectivesThe objectives of the study were to: (1) quantify and classify innovator medicines registered between 2010 and 2020 by the South African Health Products Regulatory Authority (SAHPRA); (2) identify barriers to accessing innovator medicines in South Africa through interviews with market access managers from innovator companies; and (3) explore the current market access strategies used by the pharmaceutical industry.DesignThis study employed a quantitative and qualitative methodology. Whereby the former involved the extraction of a list of innovator medicines from the regulator database, and the latter involved 9 semi structured interviews. Purposive sampling was conducted through pharmaceutical association member companies. The interviews included seven market access managers and two medicine managers from one of the payers in South Africa. Thematic analysis was used to interpret the data collected from the study.ResultsAccording to the regulator database during the review period, 238 innovator medicines were registered. Only 14.77% were available in the public sector in the form of tenders, whereas in the private sector (based on the products having a SEP), 76.92% were available. From the interviews six themes emerged: reimbursement of medicines, types of reimbursement, partnerships, technology, legislative challenges, and other factors (e.g., real-world evidence).ConclusionAccess to innovator medicines in South Africa is a challenge, as the price of these therapies is high. Therefore, various stakeholders in the health sector must collaborate to identify and implement solutions that are locally relevant. The government needs to proactively update policies that would allow for alternative reimbursement methods to be explored.

The impact of long-term care insurance on the utilization of inpatient service: Evidence and mechanisms in China.

This paper empirically investigates the impact of public long-term care insurance (LTCI) on the utilization of inpatient services and associated expenditures among disabled Chinese individuals, using data from the China Health and Retirement Longitudinal Study from 2011 to 2018. Employing a staggered difference-in-difference approach within a propensity score matching framework (PSM-DID), the study finds that the introduction of LTCI significantly reduces the likelihood of inpatient service usage by 4.2%, the annual number of inpatient admissions by 10.2%, the annual inpatient cost by 16.2%, the out-of-pocket expenses by 20.7%, and the reimbursement expenditure by the public medical insurer by 9.9%. The study further explores the mechanisms underlying these effects and identifies that the Substitution Effect, where care services in community healthcare centers and nursing homes replace hospitalizations, outweighs the Income Effect generated by LTCI benefits. By leveraging the quasi-natural experimental setting of diverse LTCI policies across cities, the study also examines the heterogeneous impacts of LTCI based on household income, eligibility criteria, and reimbursement methods. The findings underscore the positive role of LTCI in controlling medical expenses and alleviating congestion in urban hospitals, offering valuable insights for promoting "Healthy Aging".

How hospital autonomy affects provider payment reform effectiveness.

Provider payment reforms (PPRs) have demonstrated mixed results for improving health system efficiency. Since PPRs require health care organisations to interpret and implement policies, the organizational characteristics of hospitals may affect the effectiveness of PPRs. Hospitals with more autonomy have the flexibility to respond to PPRs more efficiently, but they may not if the autonomy previously facilitated behaviours that counter the PPR's objective. This study examines whether hospitals with higher autonomy responds to PPRs more effectively. We used data from a matched-pair, cluster randomized controlled PPR intervention in a resource-limited Chinese province between 2014 and 2018. The intervention reformed the reimbursement method from the publicly administered New Cooperative Medical Scheme (NCMS) from fee-for-service to global budget. We interacted measures of hospital autonomy over surplus, hiring, and procurement (drugs, consumables, equipment, and overall index) with the difference-in-difference estimator to examine how autonomy moderated the intervention's effect. Autonomy over surplus (p<0.01) and procurement of equipment (p<0.01) were associated with relatively faster NCMS expenditure growth, demonstrating worse PPR response. They were also associated with higher expenditure shifting to out-of-pocket expenditures (p>0.05). Post hoc analysis suggests that hospitals with surplus autonomy had higher OOP per admission (p<0.01), suggesting profiteering tendencies. Other dimensions of autonomy demonstrated imprecise association. Hospitals with more autonomy may not necessarily respond more effectively to PPRs that incentivise efficiency when they had previously been encouraged to maximise profit. Policymakers should assess the extent of perverse incentives before granting autonomy and adjust the incentives accordingly.

Research on the Application and Optimization of B University Financial Integrated Information Portal System

The rapid development of information technology has brought favorable opportunities for colleges and universities to continuously innovate financial management methods and improve the quality and level of financial services, and has promoted the wide application of a comprehensive financial information portal system in colleges and universities, which integrates online reimbursement, inquiry, authorization and other functions. Therefore, taking B university as an example, this paper analyzes and discusses the functions, operation processes and advantages of the financial integrated information portal system based on the problems of its traditional manual reimbursement methods, summarizes the bottlenecks that need to be further solved in the actual operation process of the system, and puts forward targeted optimization strategies. The financial comprehensive information portal is an important part of the financial informatization of B university, which is a powerful starting point to improve the financial management, education, service and education of B university, and contributes to the financial strength for the university to truly realize the concept of "three-all education" of all-staff education, whole-process education and all-round education, with a view to providing the basis for relevant policies to optimize the financial work.

Integrated scheduling of multi-site repair tasks considering customer preferences under a novel two-dimensional combination warranty strategy

Current warranty strategies typically focus on the interests of either the manufacturer or the customer, and fail to meet the diverse needs of the customers, as they only consider a single reimbursement or repair method. Furthermore, these strategies neglect out-of-warranty customers, resulting in a loss of profit for manufacturers. To serve both in-warranty and out-of-warranty customers, a novel two-dimensional combination warranty strategy is proposed in this paper which combines two reimbursement methods and two repair methods. Under the two-dimensional combination warranty strategy, we establish an integrated scheduling model for determining repair strategies and allocating service resources, referred to as 2DCW-MSRASM. In 2DCW-MSRASM, the manufacturer arranges appropriate warranty strategies for in-warranty orders according to the corresponding product conditions (age and usage), while for out-of-warranty customers, the manufacturer makes decisions based on its own resource situation and customer preferences. The objective of 2DCW-MSRASM is to achieve an optimal scheduling that maximizes the manufacturer’s profit and the satisfaction of both in-warranty and out-of-warranty customers. In this model, TODIM (an acronym in Portuguese of Interactive and Multi-Criteria Decision Making) is utilized to evaluate the repair services from the customer’s perspective, which considers the limited rationality of decision-makers. An improved non-dominated neighbor immune algorithm (INNIA) is developed to solve the model, incorporating an initialization method and three problem-oriented local search operators to enhance search capability. Following that, extensive experiments are conducted to demonstrate the superiority of INNIA. Eventually, the proposed strategy is demonstrated to possess noteworthy advantages when the order size is large and the proportion of in-warranty orders is high.

Impact of Fee For Service on the Efficiency and Survival of Seguro Popular's Patients With Acute Lymphoblastic Leukemia in Mexico.

Cost containment and efficiency in the provision of health care are primary concerns for health systems that aim to provide affordable, high-quality care. Between 2005 and 2015, Seguro Poplar's Fund against Catastrophic Expenditures (FPGC) funded ALL treatment in Mexico. Before January 1, 2011, FPGC reimbursed a fixed amount per patient according to risk. In 2011, the per capita reimbursement method changed to fee for service. We used this natural experiment to estimate the impact of the reimbursement policy change on average expenditure and quality of care for ALL treatment in Mexico. We used nationwide reimbursement data from the Seguro Poplar's FPGC from 2005 to 2015. We created a patient cohort to assess 3-year survival and estimate the average reimbursement before and after the fee-for-service policy. We examined survival and expenditure impacts, controlling for patients' and providers' characteristics, including sex, risk (standard and high), the volume of patients served, type of institution (federally funded v other), and level of care. To quantify the impact, we used a regression discontinuity approach. The average reimbursement for standard-risk patients in the 3-year survival cohort was $16,512 US dollars (USD; 95% CI, 16,042 to 17,032) before 2011 and $10,205 USD (95% CI, 4,659 to 12,541) under the fee-for-service reimbursement scheme after 2011. The average annual reimbursement per patient decreased by 136% among high-risk patients. The reduction was also significant for the standard-risk cohort, although the magnitude was substantially smaller (34%). As Mexico's government is currently restructuring the health system, our study provides evidence of the efficiency and effectiveness of the funding mechanism in the Mexican context. It also serves as a proof of concept for using administrative data to evaluate economic performance and quality of care of publicly funded health programs.

RWD73 Exposing the True Economic Impact of Stroke: A Comparative Analysis of Time-Driven Activity-Based Costing and Reimbursement Methods in Brazil

RWD73 Exposing the True Economic Impact of Stroke: A Comparative Analysis of Time-Driven Activity-Based Costing and Reimbursement Methods in Brazil

Stakeholders' Perceptions Regarding Digital Therapeutics Reimbursement in South Korea: Qualitative Study.

Digital therapeutics (DTx) are therapeutic interventions driven by software and directly provided to patients, allowing them to manage their health with ease in any setting. A growing interest in DTx has spurred a discussion concerning their reimbursement pathways. However, DTx are still at a premature stage, with insufficient evidence on effectiveness, efficiency, and safety. Currently, although industries desire to quickly enter the market, especially by getting their products reimbursed by the National Health Insurance (NHI) fund, the NHI is cautious about DTx due to their uncertainties. Thus, public discussion and social consensus are crucial in deciding whether to reimburse DTx by the NHI fund. This study examined multiple stakeholders' awareness and attitudes toward DTx and perceptions of regulatory pathways for adopting DTx. In-depth interviews were conducted with 11 stakeholders in South Korea (industry: n=4, health care: n=3, academia: n=2, and consumer: n=2) using semistructured guidelines. They were purposively sampled to identify individuals with expertise in DTx and NHI policies. The interviews were conducted either in person or via a videoconference for 45-70 minutes. Qualitative data were analyzed using directed content analysis, which uses interview guidelines as an analytical framework. Findings were divided into three categories: (1) awareness and attitude toward DTx, (2) perception of whether DTx are worth entering the market and being reimbursed by the NHI fund, and (3) perception of how to enter the market and how to reimburse DTx by the NHI fund if they are worth it. Although consumer stakeholders were not familiar with the basic concept of DTx, the other stakeholders understood it thoroughly. However, all participants showed positive attitudes and acceptance of DTx. Most of them responded that DTx are worth entering the market, but they could not reach an agreement on the pathways for DTx to enter the market. Although participants were in favor of the reimbursement of DTx in principle, they responded that a conservative approach is required due to insufficient clinical evidence for DTx. We found that stakeholders in South Korea had positive attitudes toward DTx, perceived them as worth using, and agreed to allow them to enter the market. The main issue was not the problem of the technology itself but the difference in opinion as to the pathways for reimbursement. Therefore, this study concluded that the NHI fund, which is operated very conservatively, is insufficient to quickly adopt and implement DTx. Various reimbursement methods, including tax-based financing, raising innovation funds for new technologies, and pilot studies using the NHI fund, should be used to rapidly generate clinical evidence and reduce the uncertainties of DTx to secure a stable market.

Preference for human papillomavirus vaccine type and vaccination strategy among parents of school-age girls in Guangdong province, China

In China, the human papillomavirus (HPV) vaccination coverage among age-eligible girls is rather low, and parent’s attitude often plays a determinant role in their girls’ HPV vaccination. To accelerate HPV vaccination coverage, several cities and Guangdong province in China offered different HPV vaccine types with different reimbursement methods. In April 2022, we conducted a province-wide survey to investigate parents of children aged 9–15 in Guangdong province, and analyzed factors associated with their preference for HPV vaccine type and vaccination strategy. Of the 4,967 surveyed respondents, 2,610 (58.1%) have not yet vaccinated their children. Among these parents, 67.9% preferred to vaccinate their children with the nine-valent vaccine, while only 8.1% preferred the quadrivalent vaccine and 7.4% preferred the bivalent vaccine. More parents preferred fixed subsidies with free choices of HPV vaccine type over the domestic bivalent vaccine provided by the government (58.1% vs. 39.3%). The multinomial logistic regression showed that parents’ relationship with children, educational level, household income, and vaccination status were significantly associated with parents’ preference for HPV vaccine type. Parent’s relationship with children, workplace, household income, vaccination status, and age of children, were significantly associated with parents’ preference for HPV vaccination strategy. Our findings suggest that policymakers may consider adjusting the current vaccination strategy by offering more vaccination choices. More health education on HPV vaccine and vaccination should also be provided to parents of age-eligible girls. Future research should examine which HPV vaccination strategy is more effective in promoting HPV vaccine uptakes in China.

Telemedicine from Home or the Office: Perceptions of Mental Health Providers.

Introduction: The COVID-19 pandemic led to a rapid transition to telemedicine for mental health care and redefined many providers' work environments and practices. The purpose of the study was to investigate the impact of work location on telemental health (TMH) benefits, disruptions, and concerns to further understand the rapid implementation of telemedicine for mental health treatment. Methods: A sample of 175 practicing TMH providers completed an online survey between July and August 2020. Providers answered questions about personal demographics and practice characteristics. Next, they answered questions about benefits, disruptions, and concerns regarding the use of telemedicine in their practice. Chi-square and independent samples t-test were conducted to identify work location differences for personal demographics and clinical practice characteristics. Three multivariate analyses of covariance were conducted to examine overall differences in perceptions of telemedicine benefits, concerns, and disruptions based on work location while covarying for provider race, ethnicity, percentage of caseload seen through telemedicine, practice type, specialty, and primary method of reimbursement. Results: TMH providers who primarily work from an office reported more benefit of reduced costs/overhead (ηp2 = 0.039), less benefit of limiting the spread of the virus (ηp2 = 0.028), and more concern about reimbursement (ηp2 = 0.046) than those who primarily work from home. We observed no difference in disruptions, patient access to care, quality of care, and work-life balance. Discussion: Exploration into work location of TMH providers aids in understanding of clinical workflows and provider wellbeing. Our findings suggest that telemedicine may be easily integrated into different types of clinical workflows and work locations.

DYNAMICS IN COSTS AND THE NUMBER OF PATIENTS OF THE FIVE MOST RESOURCE-CONSUMING DISEASES PAID WITH PUBLIC FUNDS FROM THE NATIONAL HEALTH INSURANCE FUND FOR HOME TREATMENT

On a global scale, health care costs are constantly growing, with a large part of them taking up the costs of medicinal products. The trend for the increase in the consumption of medicinal products is due to the following main reasons: the aging of the population, the possibility of medical treatment of more and more diseases and the development of new medicinal products. A challenge for the governments of individual countries is how, with limited financial resources, to ensure access for the widest possible range of patients to the best medicines. One way to contain health care costs is the reimbursement method. At the same time, a guarantee is needed that decisions to pay for publicly funded medicines are based on cost-effectiveness criteria.The purpose of the current study is to track the dynamics of the costs of medicinal products, medical devices and dietetic foods for home treatment and the number of sick health insured persons from the five most resource-intensive diseases, paid with public funds from the National Health Insurance Fund in Bulgaria for 2021 and 2022.Materials and methods: Documentary method - monthly statements of the National Health Insurance Fund for costs and number of patients for medicinal products, medical devices and dietary foods for home treatment, according to the ICD code of the disease; Economical analysis; Medical statistical methods; Tabular and graphical analyzes - to visualize the obtained results.Results and analysis: Based on the results obtained from the study, it is clear that for the observed period the total costs of medicinal products for home treatment reimbursed by the NHIF increased by 11.43%. Of the five most resource-intensive diseases, the disease for which the most public funds are spent on medicinal products for home treatment is Non-Insulin-Dependent Diabetes Mellitus, with neurological complications, and the highest rate of increase in spending in 2022 is Non-Insulin-Dependent Diabetes Mellitus, without complications – with 18.3%.Conclusion: In contrast to the upward trend in the costs of medicinal products, we observe a slight downward trend in the total number of sick persons with mandatory health insurance in 2022 compared to 2021. In the total number of patients for whom public funds were spent on medicinal products for home treatment by the NHIF, the reduction was 0.97%. Despite the general trend, with the most resource-intensive diseases under consideration, the number of patients slightly increased, with the exception of only one of them.

Challenges of Implementation of Insurance Coverage Program for Infertility Services in Iran

Background: Population has long been known as the most important pillar of governments and societies. However, in recent years, the rate of infertility is increasing rapidly due to various reasons. Objectives: This study aimed to identify the factors and challenges affecting the implementation of insurance coverage program for infertility services in Iran for the policymakers and implementers of the program. Accordingly, the correct implementation of this program provides the possibility for infertile couples to benefit from the services of this program. Methods: This qualitative study was conducted in 2022. Purposive sampling was used for selecting a total of 20 Iranian scientific and executive experts of health system with work experience, especially in the field of infertility. The interviews were conducted in a semi-structured manner and analyzed using the content analysis method and MAXQDA 2020 software. Results: The results showed that the challenges of this program include 6 main themes along with 39 sub-themes. The main themes are challenges of upstream laws and legal requirements; provision of health services; human resources; the service package and its pricing; financial issues, budgets, and methods of service cost reimbursement; and information technology challenges. Conclusion: Although the service package is defined and announced, the implementation of this plan faces many challenges due to not taking into account the implementation conditions and requirements. By examining the problems of infertility insurance coverage, the present study provides a comprehensive and practical picture of these problems. Accordingly, the factors that can make the program successful in the future consist of inclusion of a part of the services related to infertility treatment in the package of insurance services, the awareness of managers and policy makers about the challenges of implementing this program, providing financial, electronic, and human resources needed by the program, and development and modification of standards of the program.

Healthcare Finance and Reimbursement Methods: The Case of Diagnosis Related Groups

Sağlık hizmetlerinin finansmanı, bir sağlık sisteminin sürdürülebilirliğini, etkililiğini ve performansını etkileyen temel unsurudur. Uygun bir geri ödeme yöntemi sağlık hizmetlerinin finansman sorununu ortadan kaldırarak sağlık hizmetlerinin sunulmasını sürdürülebilir kılacaktır. Bu çalışmanın amacı, Sağlık Bakanlığı’na bağlı 235 yataklı B grubu genel bir hastanenin Teşhis İlişkili Gruplar verisi ışığında 2019 yılına ait Vaka Karması İndeksini (VKİ) hesaplayıp hizmet sunulan hasta grubunun kompleksliğini saptamaktır. Hastanenin 2019 yılına ait, ortalama hastane yatış gün sayısı, taburcu sayısı, yoğun bakım yatış gün sayısı, hastane yatış gün sayısı ve TİG verileri değerlendirmeye alınmıştır. Hastanenin toplam bağıl değeri vaka sayısına bölünerek aylık Vaka Karması İndeksi hesaplanmıştır. Aylık olarak TİG verileri incelenip hastanenin hangi aylarda daha komplike, hangi aylarda daha az komplike vakalara bakıldığı saptanmıştır. Aylık VKİ değerlerinin ortalaması hesaplanarak hastaneye ait 2019 yılına ait VKİ hesaplanmıştır. Verilerin düzenlenmesinde ve analizinde M. S. Excel programı kullanılmıştır. Hastanede 2019 yılında 2039 kodda 15.571 hastaya hizmet sunumu gerçekleştirilmiştir. 2019 yılına ait vaka karması indeksi 0,81 olarak bulunmuştur. VKİ en yüksek mart (0,88) ayında gerçekleşmiştir. Sağlık kurumlarının sağlık hizmetini talebini karşılamaları mevcut kaynakların hakkaniyet çerçevesinde kullanılmasıyla mümkündür. Kaynakların hakkaniyete uygun dağılmasının yanı sıra geri ödeme yöntemleri de önem arz eden bir diğer husustur.

Exploring the Membership Pharmacy Model: Initial impact and feasibility.

There is a need to shift pharmacy payment models, given the expanding role of the community pharmacist in improving patient outcomes, misaligned incentives of the existing reimbursement model, and deleterious effects of a lack of transparency on prescription costs. The primary objective of this paper was to develop a payment strategy for a Membership Pharmacy Model within an independent community pharmacy setting. A secondary objective of this paper is to explore the early impact of a novel value-based pharmacy payment model on patients, pharmacies, and self-insured employers. Good Shepherd Pharmacy, a nonprofit Membership Pharmacy founded in Memphis, TN, in2015. We discuss a novel, value-based payment model for community pharmacy, which involves a partnership between pharmacy and employer, without the use of a pharmacy benefit manager, using a recurring (i.e., membership pharmacy) business revenue model. The pilot program was assessed using the RE-AIM framework. The pilot enrolled 34 patients for whom 1399 prescriptions were filled spanning 13 quarterly refill cycles from January 2019-March 2022. After the intervention, proportion of days covered for diabetes and cholesterol medications both increased: 96.7% and 100% (P < 0.05); 90.3% and 98.1% (P > 0.05). Financial savings for the employer group were realized across both fee charges and prescription medication costs. The net savings provided to the employer was $67,843, a 35% reduction in topline pharmacy spending. Revenue for the pharmacy was realized exclusively through synchronization fees of $30 per fill. Synchronization fees for the entire study totaled $41,970, and the average revenue per quarterly batch refill was $3228. The Membership Pharmacy Model represents a potentially viable alternative to traditional fee-for-service, buy-and-bill pharmacy payment models through its use of medication pricing based on actual acquisition costs, lean pharmacy operations, and value-based reimbursement methods.

Cost and reimbursement analysis of end-of-life cancer inpatients. The case of the Greek public healthcare sector

BackgroundWhile hospital-based Palliative Care services are usually covered through the main funding healthcare framework, traditional reimbursement methods have been criticized for their appropriateness. The present study investigates for the first time the case of treating end-of-life cancer patients in a Greek public hospital in terms of cost and reimbursement. MethodsThis retrospective observational study used health administrative data of 135 deceased cancer patients who were hospitalized in the end of their lives. Following the cost estimation procedure, which indentified both the individual patient and overhead costs, we compared the relevant billing data and reimbursement requests to the estimated costs. ResultsThe average total cost per patient per day was calculated to be 97 EUR, with equal participation of individual patient’s and overhead costs. Length of stay was identified as the main cost driver. Reimbursement was performed either by per-diem fees or by Diagnosis Related Groups’ (DRGs), which were correspondingly associated with under or over reimbursement risks. In the case of the combined use of the two available reimbursement alternatives a cross-subsidization phenomenon was described. ConclusionAlthough the cost of end-of-life care proved to be quite low, the national per-diem rate fails to cover it. DRGs designed for acute care needs are rather unsuitable for such sub acute hospitalizations. Policy summaryThere is a concrete need for reconsidering the current reimbursement schemes for this group of patients as part of any national plan concerning the integration and reformation of Palliative Care services. Otherwise, there is a serious danger for public institutions’ reluctance to admit them with a serious impact on access and equity of end-of-life cancer care.

Payment systems for dialysis and their effects: a scoping review

BackgroundEnd stage renal disease (ESRD) is a major health concern and a large drain on healthcare resources. A wide range of payment methods are used for management of ESRD. The main aim of this study is to identify current payment methods for dialysis and their effects.MethodIn this scoping review Pubmed, Scopus, and Google Scholar were searched from 2000 until 2021 using appropriate search strategies. Retrieved articles were screened according to predefined inclusion criteria. Data about the study characteristics and study results were extracted by a pre-structured data extraction form; and were analyzed by a thematic analysis approach.ResultsFifty-nine articles were included, the majority of them were published after 2011 (66%); all of them were from high and upper middle-income countries, especially USA (64% of papers). Fee for services, global budget, capitation (bundled) payments, and pay for performance (P4P) were the main reimbursement methods for dialysis centers; and FFS, salary, and capitation were the main methods to reimburse the nephrologists. Countries have usually used a combination of methods depending on their situations; and their methods have been further developed over time specially from the retrospective payment systems (RPS) towards the prospective payment systems (PPS) and pay for performance methods. The main effects of the RPS were undertreatment of unpaid and inexpensive services, and over treatment of payable services. The main effects of the PPS were cost saving, shifting the service cost outside the bundle, change in quality of care, risk of provider, and modality choice.ConclusionThis study provides useful insights about the current payment systems for dialysis and the effects of each payment system; that might be helpful for improving the quality and efficiency of healthcare.

Public-private partnership in primary health care: an experience from Iran.

The aim of this paper is to introduce the experience of applying public-private partnership (PPP) in providing primary health care (PHC) in East Azerbaijan Province (EAP), Iran. Moving toward the Universal Health Coverage (UHC) involves using of all health-related resources. Certainly, one of the key strategies for achieving UHC is PPP. Since 2015, a PPP in PHC policy has begun in EAP as a major strategy for strengthening the health system and achieving UHC. In this case study, data were collected through interviews with stakeholders, document analysis, reviewing of health indexes and published studies. The data were analyzed using content analysis. PPP in PHC policy was designed and implemented in EAP with the aim of social justice, strengthening the health system and achieving UHC in the framework of health complexes (HCs). HCs provide a defined service package according to the contract. The reimbursement method is a combination of per capita, fee for services and bonus methods. Part of the payments is fixed and the other part is based on the pay for quality system and paid according to the results of monitoring and evaluation. According to the study results, the most important strength of the plan is to improve access to services, especially in marginalized areas. The main weakness is not providing infrastructures before the implementation of the plan, and the most important challenges are financial, political and organizational unsustainability and, sometimes, poor cooperation by the other organizations. The findings show that PPP in PHC in EAP is an effective strategy to provide social justice, implement family practice and achieve UHC.

Κοστολόγηση Υπηρεσιών στη Μονάδα Εντατικής Θεραπείας με τη χρήση των DRGs στις χώρες του ΟΟΣΑ

The trend for quality, efficient, and productive financing of health service providers, especially Intensive Care Units (ICUs), has become increasingly evident in recent decades. In this study, we investigate the prospective reimburse- ment method, per case of hospitalization in the ICU, according to the Diagnostic Related Groups (DRGs), in the OECD countries, as well as the appropriateness of using the method, in the particular environment of the ICU. A systematic review of papers published up until July 2022 was conducted. The search was performed on PubMed, Medline, Scopus, ScienceDirect, and Google Scholar. The criteria for inclusion in this review were the calculation by researchers of the appropriateness of using DRGs in the ICU, as a method of reimbursement, through comparison with the actual cost of hospitalization of patients in the ICU. Only sixteen(16) of the scientific papers retrieved met the criteria for inclusion in this review. Ten(10) studies assessed the appropriateness of applying DRGs as a reim- bursement method in adult ICUs and six(6) assessed the appropriateness of applying DRGs as a reimbursement method in Neonatal Intensive Care Units and pediatric ICUs. Discrepancies were observed between the actual cost of hospitalization and the reimbursement amount in all categories of ICUs. Finding the right DRG system, combined with other financing methods, would be a useful policy tool to help manage finances, contain costs, and provide quality health services.

PP14 Value-Based Pricing For Advanced Therapy Medicinal Products: Emerging Affordability Solutions

IntroductionThe emergence of advanced therapy medicinal products (ATMPs), a disruptive class of health technologies, is generating important challenges in terms of value assessment, and their high prices introduce critical access and affordability concerns.MethodsThe aim of this oral presentation is to expose the challenges of traditional value assessment and pricing and reimbursement methods in the evaluation of ATMPs, and to characterize the current and prospective financing solutions that may ensure patient access to and affordability for these health technologies.ResultsStandard health technology assessment (HTA) is not designed for assessing ATMPs and may delay access to these therapies; thus, a broader concept of value is required. As a result, value-based pricing methodologies have been gaining prominence as a way to cope with the specific challenges of ATMPs. The pricing and reimbursement framework should ensure a balance between encouraging innovation and maximizing value for money for payers through the attribution of a fair price to new health technologies. The provision of early scientific advice to developers by regulatory and HTA bodies is key, as it will help diminish the perspective gap between developers, regulators, and payers.ConclusionsThe high efficacy and high price dynamic of many ATMPs necessitates novel financing models, both in the European Union and in the USA. Managed entry agreements, where financing is conditional upon the submission of additional evidence, linked with leased payments may offer effective strategies to address the uncertainties caused by the evidence gap associated with ATMPs, ensuring affordable and sustained access to these therapies.

MarkeTrak and EuroTrak: What We Can Learn by Looking Beyond the U.S. Market.

The MarkeTrak survey of the trends in hearing aid use, satisfaction and adoption in the United States has been conducted since 1989 by the Hearing Industries Association. It provide the hearing aid industry with valuable about the consumers view of the products and services within the industry. The EuroTrak survey is conducted by the European Hearing Instrument Manufactures Association. It is the counterpart to MarkeTrak and provides similar data for over a dozen countries in Europe, and Asia. While there are differences in the distribution models and reimbursement methods for these counties, many of the key metrics concerning hearing aid use and satisfaction can be compared.