Outcome-based reimbursement in Central-Eastern Europe and Middle-East

Abstract

Outcome-based reimbursement models can effectively reduce the financial risk to health care payers in cases when there is important uncertainty or heterogeneity regarding the clinical value of health technologies. Still, health care payers in lower income countries rely mainly on financial based agreements to manage uncertainties associated with new therapies. We performed a survey, an exploratory literature review and an iterative brainstorming in parallel about potential barriers and solutions to outcome-based agreements in Central and Eastern Europe (CEE) and in the Middle East (ME). A draft list of recommendations deriving from these steps was validated in a follow-up workshop with payer experts from these regions. 20 different barriers were identified in five groups, including transaction costs and administrative burden, measurement issues, information technology and data infrastructure, governance, and perverse policy outcomes. Though implementing outcome-based reimbursement models is challenging, especially in lower income countries, those challenges can be mitigated by conducting pilot agreements and preparing for predictable barriers. Our guidance paper provides an initial step in this process. The generalizability of our recommendations can be improved by monitoring experiences from pilot reimbursement models in CEE and ME countries and continuing the multistakeholder dialogue at national levels.

Challenges and opportunities for improvement in the management and financing system of Health Promotion Offices in Hungary

“…Recommendation for improvement 9: Given the complex and intersectoral nature of public health activities, innovative financing mechanism might be valid to explore. One such tool is outcome-based contracting, used mostly in Anglo-Saxon countries to combine advantages of public and private sector ( 71 – 74 ). This contractual arrangement allows payment after the demonstration the achievement of mutually agreed outcomes.…”

When Reality Does Not Meet Expectations—Experiences and Perceived Attitudes of Dutch Stakeholders Regarding Payment and Reimbursement Models for High-Priced Hospital Drugs

“…Outcome-based reimbursement models and delayed payments models are seen as promising alternatives to reduce remaining (clinical) uncertainties, diminish the budget impact, share financial risks, and improve/ensure patient access [21,52,53]. Nonetheless, it is still debated how much is and can be gained with the implementation of outcome-based reimbursement and delayed payment models due to their complexity and administrative burden [27][28][29][30][31][32]54]. The perceived barriers stakeholders expressed when implementing the preferred outcome-based reimbursement and delayed payment models clarify why the preferred models are currently not yet commonly applied in the Netherlands.…”

“…Correspondingly, the main reason why discounts and upfront payments are experienced best according to the respondents, namely the simplicity of these agreements, can be explained. Some of the described barriers perceived were also more broadly experienced across Europe and the United States [7,16,27,28,31,32,36,52,54]. Bohm et al presented a clear overview of the main challenges related to successfully implementing outcome-based agreements across Europe, namely the lack of useful negotiation frameworks; difficulties in determining outcomes; the burden of data administration and implementation; and laws and regulation [22].…”

“…In the previous literature, stakeholders emphasized that several goals have been achieved by implementing more complex payment and reimbursement models, such as providing earlier patient access to new treatments, reducing remaining (clinical) uncertainties or managing high budget impact [4,7,24]. Nevertheless, it is argued that these agreements are often not transparent and are complex to implement [22,24,27,28]. Additionally, many examples of unsuccessful implementation also exist [29][30][31][32][33].…”