In January 2021, we performed the first annual survey of our customers to synch with our internal knowledge about key developments in the area of market access in European countries.

Our team maintains a good level of understanding of reimbursement processes via routine monitoring of reimbursement systems via our Reimbursement and HTA Alerts services, project work, interviews, and engagement with the clients.

This year, we have decided to ask our clients about their understanding of the key developments of reimbursement systems in 2020 and anticipated changes in 2021. This report provides a brief summary of key internal findings and information obtained from the participants of the survey.

The year 2020 was shaped by the COVID-19 crisis, and it led to a pause on elective procedures, growth of waiting lists, introduction of reimbursement for remote consultations in some countries (e.g., in Belgium and the Netherlands), and delayed capital investments. But COVID-related crisis did not lead to any conceptual changes of the reimbursement frameworks. Therefore, we will not be focusing on them in this report.

There are several key trends that we want to acknowledge in this report:

• The attention of decision-makers and payors to the approval of medical technologies. Examples: establishing national organizations to guide the selection of innovations in Denmark and Sweden;
• Development of reimbursement for health apps. This is true not for any digital technologies but specifically for health apps used for patient-centered care. Examples: new reimbursement schemes were established in Belgium, France, and Germany;
• Making payment systems more flexible. Examples: abolishing activity-based (HRG-based) reimbursement system in England; ability to innovate locally on payment mechanisms in the Netherlands.

Some areas remained without significant development, for example, HTA frameworks in most countries.