Funding decisions by payers for medical technologies in Europe

Syndicated report on all published funding decisions for medical technologies by ultimate payers and decisions-makers in five European countries

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The funding reflects a willingness to pay for procedure or device by payers.

Funding is different from reimbursement, which is the method to pay for procedure (e.g. via diagnosis-related group). 

Procedure can have a procedure code and be grouped into DRG with sufficient tariff, but payers do not want to pay for the procedure, which results in this procedure not having coverage in the target country. This is the case, for example, for robotic surgery in England. Robotic surgery is approved for funding by NHS England for some indications (e.g. prostatectomy) and not approved for others (e.g. bladder cancer).

Therefore, funding represents the unique market access challenge, which should be well understood. Explicit funding frameworks exist in England, Germany, the Netherlands, Norway and Switzerland.

This report, containing all funding decisions from payers, provides unique insight into type of decisions made by payers, activity of different payers (e.g. number of reports), frequency of positive and negative decisions. This information can shape market access strategy and enable better planning of evidence generation and timing of engagement with payers. 

This report complements the series of MTRC analytical reports in the field of reimbursement for medical technologies, including reports on HTA for medical technologies in 2018 and innovation payment schemes in 2019.

Key features of the report

5 EU countries

Decisions are collected from the countries with established funding frameworks: England, Germany, the Netherlands, Norway and Switzerland

6 payor and decision-making organizations

National and regional (one Clinical Commissioning Group in England) organizations are included

Devices, procedures and IVD tests

Data about all non-drug decisions are included into the report

Overview of funding frameworks

Brief overview of each funding framework is provided

Key information and summary statistics

For each report, information about type of technology (e.g. neurostimulator, cardiovascular) and decisions (positive or negative) is included. Summary statistics is provided

List of all published decisions (>1000)

All decisions per country/organization are listed in the table format including organization, title, type of technology, decision and web-link. Optionally, access the full list in MS Excel

Obtain sample pages

Click to the link below to obtain sample pages, including description of the funding framework in England, summary statistics and sample of policies of NHS England

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Specifics of the report

 

England: All commissioning policies by NHS England for nationally commissioned procedures; procedures from the List of restricted technologies from one Clinical Commissioning Group - North Staffordshire CCG. Service specifications are not included

Germany: Technologies included into G-BA Directives for hospital care

Netherlands: Decisions about coverage of procedures in the Basic Health Insurance by the Dutch Health Care Institute (Zorginstituut Nederland)

Norway: Decisions of the Decision Forum of the "New Methods" framework

Switzerland: Decisions about coverage of services within statutory health insurance by the Federal Office of Public Health

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