After publishing The Diagnostics Reimbursement Compass: A 90-Minute Guide to Define, Demonstrate and Capture Diagnostics Value Confidently we have also created some short “explainer” videos.
Check out: #3 – What are the key diagnostics reimbursement pathways and stakeholders?
Reimbursement drives access to diagnostic solutions
Diagnostic solutions can be paid directly by patients via out-of-pocket payments or indirectly via various mandatory or voluntary health insurance options. In many developed countries, private health insurance often supplements public insurance and covers co-payments, deductibles, and specific services.
In an inpatient setting, most of the time, hospital laboratories would perform the diagnostic tests. They operate under global budgets and negotiate with suppliers on diagnostic instruments, tests, and consumables.
In an outpatient setting, national and/or regional tariff schedules govern test coverage.
Reimbursement via tariff schedules offer long-term coverage. To facilitate access to novel (digital) diagnostic solutions, there is a growing number of temporary funds that provide limited, conditional coverage to innovative solutions.
Manufacturers, laboratory experts, and physicians can request the coverage, based on their medical and professional needs. HTA bodies evaluate and formulate recommendations from clinical and economic perspectives, while public and private health insurance funds and hospital management decide on diagnostics’ coverage, price, or budget. The manufacturer can play a direct role in the submission or may indirectly assist all these stakeholders, with supportive technical, clinical, and economic evidence