Impact of reimbursement policies on the adoption of medical devices in an outpatient setting |
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| Institution: | 1. LSE Health, London School of Economics, London, UK;2. European Health Technology Institute, Brussels, Belgium;3. Centre for Health Economics, University of York, UK;1. School of Psychological Sciences, Monash University, Clayton, Australia;2. Monash Alfred Psychiatry Research Centre, The Alfred and Monash University, Central Clinical School, Melbourne, Australia;1. Center for Health Statistics and Information, People?s Republic of China;2. National Health and Family Planning Commission, People?s Republic of China;1. College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), National Guard Health Affairs (NGHA), P.O. Box 22490, Riyadh 11426, Saudi Arabia;2. School of Health Information Science, University of Victoria, Victoria, BC, Canada;1. Vancouver Island Health Authority (VIHA), 1 Hospital Way, Victoria, BC, Canada V8Z 6R5;2. Department of Pharmacy, Royal Jubilee Hospital, VIHA, Victoria, BC, Canada;3. Faculty of Pharmaceutical Sciences, The University of British Columbia, Canada;4. Clinical Pharmacy Programs, VIHA, Nanaimo, British Columbia, Canada;5. Vancouver Coastal Health, Canada;6. Department of Emergency Medicine, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada;1. Centre for Comparative Genomics, Murdoch University, Perth, Western Australia;2. National Centre for Genome Resources, Sante Fe, New Mexico, USA;3. Department of Physiology, Biochemistry & Molecular Biology, Monash University, Victoria, Australia;4. US Department of Agriculture, Agricultural Research Service, Knipling-Bushland, US Livestock Insects Research Laboratory, Kerrville, Texas, USA;5. Western Australian Neuroscience Research Institute & Centre for Neuromuscular and Neurological Disorders, University of Western Australia, Nedlands, Western Australia;6. Genetic Services of Western Australia, King Edward Memorial Hospital, Perth, Western Australia;7. Office of Population Health Genomics, Public Health & Clinical Services Division, Department of Health, Western Australia;8. School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia;9. Institute for Immunology and Infectious Diseases, Murdoch University, Perth, Western Australia;10. Genetic Services & Familial Cancer Program of Western Australia, Subiaco, Western Australia;11. Office of Rare Disease Research, National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, Maryland, USA;12. Community Genetics, School of Medical Sciences, Edith Cowan University, Western Australia;13. Department of Physiology & Biophysics, Weill Cornell Medical College, New York, New York, USA;14. The HRH Prince Alwaleed Bin Talal Bin Abdulaziz Alsaud Institute for Computational Biomedicine, Weill Cornell Medical College, New York, New York USA;15. The Feil Family Brain & Mind Research Institute, Weill Cornell College, New York, New York, USA;p. Public Health & Clinical Services Division, Western Australia Department of Health, Perth, Western Australia;1. IBM, United Kingdom;2. IBM, Canada |
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| Abstract: | ObjectivesTo consider how reimbursement systems in the UK, Germany, Italy, France and Spain affect adoption of medical devices that facilitate care in an ambulatory setting.MethodsExamples of technologies that could be used in an outpatient setting but are predominantly used on inpatients were identified. Hospital payment systems were explored and the implications of funding policies for the adoption of medical devices in an outpatient setting considered.ResultsAlthough many countries attempt to develop ambulatory care payments, their DRG/HRG systems introduce a time lag for the uptake of new treatments and do not routinely identify and adopt enabling technologies. Arrangements to fund new technologies are often localised and inconsistent which can result in missed opportunities for savings. There are fewer reimbursement codes for outpatient procedures and this appears to present a barrier to the take-up of new technologies that reduce inpatient bed days. Current levels of outpatient fees are suited to fast, high volume, low cost procedures.ConclusionsThis review identifies attempts to improve coding tariffs, increase the frequency of updates and introduce more out-patient DRG codes. Healthcare payers need to be satisfied that new technologies are cost effective before they agree funding outside DRG based fee systems and the negotiation process would be more efficient if payers pooled expertise for reviewing cost-effectiveness evidence and fed conclusions directly to tariff setting authorities. New DRG codes and higher outpatient tariffs for cost effective technologies that enable a switch to ambulatory care could incentivise hospitals to revise care pathways. |
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| Keywords: | Medical devices Health systems Procurement Financing Reimbursement systems Medical technology |
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