Module 17 2024

03/12/2024

Medical Reimbursement Challenges

• The gap between the value of a technology and reimbursement levels • In many countries, rates of medical reimbursement are not based on value of the product (cost to mfg.), rather it is cost-based as related to a specific use case or treatment paradigm (return on health investment) • The rates of reimbursement are fixed by a government body in most of the countries based on information provided to establishing clinical benefit by the manufacturer. • This body is mainly comprised of government officials or clinicians and they decide on what the rates of reimbursement should be for specific medical devices and procedures. • Such decisions are not based on the technology of the manufacturer or the feature of the device but are driven by standing formulas. • This means that as such a medical reimbursement is a reflection of the cost to use a certain device and its impact in clinical outcome or procedure and does not reflect the technology used in it. • The challenge is to match reimbursement levels with the type of technology used in the medical device. This balance is essential to a positive outcome.( and ensuring the availability of advanced medical technologies to the patients in the future.) The current fiscal situation in nearly every country is having a profound impact on this

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Medical Reimbursement Challenges

• Cuts in government medical reimbursement spending • Post pandemic, every country is looking for various ways to cut down on their costs of healthcare • This includes reducing medical reimbursement amounts and deciding which devices will be on their list • Most governments have already begun to reduce their spending on the reimbursement of medical devices and reduced the total healthcare spending seeking the largest clinical benefit ROI.

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