In Germany, some digital health applications (DiHA) became reimbursable through the statutory health insurance system with the adoption of the Digital Healthcare Act in 2019. Approaches and concepts for the German care context were developed in an iterative process, based on existing concepts from international experience. A DiHA categorization was developed that could be used as a basis to enable the creation of a reimbursed DiHA repository, and to derive evidence requirements for coverage and reimbursement for each DiHA. The results provide an overview of a possible classification of DiHA as well as approaches to assessment and evaluation. The structure of remuneration and pricing in connection with the formation of groups is demonstrated.
Background and purpose: Complex surgery and radiotherapy are the central pillars of loco-regional oncology treatment. This paper describes the reimbursement schemes used in radiation and complex surgical oncology, reports on literature and policy reviews. Material and methods: A systematic review of the literature of the reimbursement models has been carried out separately for radiotherapy and complex cancer surgery based on PRISMA guidelines. Using searches of PubMed and grey literature, we identified articles from scientific journals and reports published since 2000 on provider payment or reimbursement systems currently used in radiation oncology and complex cancer surgery, also including policy models. Results: Most European health systems reimburse radiotherapy using a budget-based, fee-for-service or fraction-based system; while few reimburse services according to an episode-based model. Also, the reimbursement models for cancer surgery are mostly restricted to differences embedded in the DRG system and adjustments applied to the fees, based on the complexity of each surgical procedure. There is an enormous variability in reimbursement across countries, resulting in different incentives and different amounts paid for the same therapeutic strategy. Conclusion: A reimbursement policy, based on the episode of care as the basic payment unit, is advocated for. Innovation should be tackled in a two-tier approach: one defining the common criteria for reimbursement of proven evidence-based interventions; another for financing emerging innovation with uncertain definitive value. Relevant clinical and economic data, also collected real-life, should support reimbursement systems that mirror the actual cost of evidence-based practice.
Background and purpose: Complex surgery and radiotherapy are the central pillars of loco-regional oncology treatment. This paper describes the reimbursement schemes used in radiation and complex surgical oncology, reports on literature and policy reviews. Material and methods: A systematic review of the literature of the reimbursement models has been carried out separately for radiotherapy and complex cancer surgery based on PRISMA guidelines. Using searches of PubMed and grey literature, we identified articles from scientific journals and reports published since 2000 on provider payment or reimbursement systems currently used in radiation oncology and complex cancer surgery, also including policy models. Results: Most European health systems reimburse radiotherapy using a budget-based, fee-for-service or fraction-based system; while few reimburse services according to an episode-based model. Also, the reimbursement models for cancer surgery are mostly restricted to differences embedded in the DRG system and adjustments applied to the fees, based on the complexity of each surgical procedure. There is an enormous variability in reimbursement across countries, resulting in different incentives and different amounts paid for the same therapeutic strategy. Conclusion:A reimbursement policy, based on the episode of care as the basic payment unit, is advocated for. Innovation should be tackled in a two-tier approach: one defining the common criteria for reimbursement of proven evidence-based interventions; another for financing emerging innovation with uncertain definitive value. Relevant clinical and economic data, also collected real-life, should support reimbursement systems that mirror the actual cost of evidence-based practice.
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Background: The exponential increase of SARS-CoV-2 infections during the first wave of the pandemic created an extraordinary overload and demand on hospitals, especially on intensive care units (ICUs), across Europe. European countries have taken different measures to surge ICU capacity, but little is known on the extent. A country level analysis was conducted to compare hospitalisation rates of COVID-19 patients in acute and intensive care and the levels of surge capacity for intensive care beds across 16 European countries and Lombardy region during the first wave of the pandemic (28 February to 31 July).Methods: We used data on infection rates and numbers of current and/or cumulative COVID-19 patients in acute and intensive care in 16 countries and Lombardy region to analyse the burden on hospitals during the first wave of the COVID-19 pandemic. Data on COVID-19 hospitalisations was continuously extracted since 20 March, 2020 from publicly available sources. To evaluate whether hospital capacities were exceeded, we retrieved information on hospital and ICU surge capacity. Treatment days and mean length of hospital stay were calculated to assess hospital utilisation by COVID-19 patients during the first wave. Results: Pre-pandemic hospital and ICU capacity varied widely across countries. In no studied country did the utilisation of acute care bed capacity by COVID-19 patients exceed 38.3%. However, the Netherlands, Sweden, and Lombardy would not have been able to treat all COVID-19 patients during the first wave without ICU surge capacity. Indicators of hospital utilisation were not consistently related to the numbers of SARS-CoV-2 infections. The mean number of hospital days associated with one SARS-CoV-2 case ranged from 1.3 (Norway) to 11.8 (France). Conclusion: In many countries, the increase of ICU capacity was important to accommodate the high demand for intensive care during the first COVID-19 wave. Our study indicates that SARS-CoV-2 incidence is not the only aspect when it comes to the burden of hospital care for COVID-19 but rather the utilisation of hospital resources as shown by cumulative hospital days and mean length of stay during the first wave. Indicators presented in this study could inform forecasting models, especially in regard to necessary surge capacity.
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