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Top 3 Medical Reimbursement Challenges for Medical Device Manufacturers and Their Impact

With respect to medical devices, reimbursement can be defined as the payment paid by a third-party public or private insurer to a health care provider in return for the payments or costs incurred by the provider for using a medical device or for performing the required procedure. If the coverage under reimbursement has no certainties, it becomes difficult to analyze return on investment. This creates obstacles in securing venture funding and also limits innovation. This, in turn, pulls back the patients from getting the advantage of new technologies. Thus, reimbursement and coverage of payers have a crucial role to play in making or breaking a device. There are many challenges associated with medical reimbursement for medical device manufacturers, which varies greatly from country to country. But there are a few common challenges that are shared by many countries. Here are the top three.Contact US

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, rather it is cost-based. The rates of reimbursement are fixed by the government body in most of the countries. This body mainly comprises 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 such a medical reimbursement is a reflection of the cost to use a certain device or procedure and does not reflect the technology used in it. But here is the challenge to match reimbursement levels with the kind of technology used in the medical device because this balance is very essential to get a positive outcome and ensuring the availability of advanced medical technologies to the patients in the future.Request Proposal

Cuts in government medical reimbursement spending

The government in countries like E.U, U.S, China, and Japan are looking for various ways to cut down on their expenditure to prevent the costs of healthcare crossing their limits. This also includes cutting down on medical reimbursement amounts. Several governments have already initiated the process to reduce their spending on the reimbursement of medical devices and this has reduced the total healthcare spending.

Opacity and complexity of reimbursement process

Medical reimbursement process is considered to be the most opaque and complex process that stops medical devices from getting exposed to advanced technologies. In many countries, there are even many stakeholders involved in the reimbursement process who interact with the companies. Many times, medical reimbursement decisions can be lengthy, uncertain, opaque and even unpredictable. Therefore, for companies to invest in new technology without knowing the amount of reimbursement becomes very difficult.Get More Info

Impact of Medical Reimbursement Challenges  

#1. Difficult to get good ROI

The gap between reimbursement rates and technology makes the investment risky for the manufacturer. The risk of ROI makes them apprehensive towards experimenting and working on innovations in medical devices.

#2 Providing quality

The opaque and lengthy system of the medical reimbursement process makes it quite difficult for the manufacturer to produce quality medical devices and provide valuable services.

#3 Difficult early diagnosis and preventive care

The government’s decision to cut down on healthcare expenditure, especially when it comes to medical reimbursement for devices and procedures, leads to difficulty in diagnosis at the early stage of disease like breast cancer, which needs a screening.

Therefore, to avoid such instances manufacturers need to take steps for their participation in the formulation of medical reimbursement rules. This will further help in advancing the innovation process in medical devices and attaining financial goals.

To know about the medical reimbursement challenges and its impact

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Market Intelligence Study on Health Economics Helps Bridge the Gap Between Demand-supply of Resources

The recent market intelligence study by Infiniti Research on health economics data helps a leading laboratory diagnostics company derive health economics data with country-specific operational, clinical, and financial data sets.

Health economics, market access, and reimbursement policies

Health economics helps analyze the size of the contribution of the healthcare sector to the overall economy and identifies the several health issues that have a substantial economic element. The theory analyses consumer, producer, and social choice to understand the behavior of public and private organizations, healthcare providers, governments, and individuals in the decision-making process. Health economics and market access have close applications as one method help develop statistical models of disease recognition and treatment areas and the other designs salesforce models to boost the sales of related drugs and therapeutics in the market. Market access and health economics are gaining immense popularity in the market as it helps bridge the gap between demand-supply of limited resources in the healthcare sector. The market intelligence team at Infiniti provides detailed insights in terms of allocating resources to bridge the gap effectively.

The data analysis gained through health economics helps regulatory bodies understand the price valuations and cost-effectiveness of various drugs and therapeutics that are available in the market. These analytics helps the government formulate pricing and reimbursement policies in the global market. The increasing cost of healthcare is one of the primary challenges that is tackled through health economics and market access evaluations.

Resource optimization at a global level

Developing health economic database with country-specific operational, clinical, and financial data sets on COF business areas, ROI calculators, and COF Wiki KPI’s will help companies gain a holistic overview of the healthcare industry. Furthermore, designing country-specific models will help pharmaceutical companies understand the market landscape of the target region and optimize new product launches. The new models offer information on cost-saving opportunities and resource allocation techniques that will fuel the growth of affordable healthcare products in the global market.


Emergence of personalized medicines

Data analysis through health economics is increasing the availability of personalized medicines in the market. The data collected analyze the genomic information and suggests different methods of drug delivery that will increase patient satisfaction. The application of these data points is valuable in the drug development process and to increase efficiency and effectiveness of health care delivery.

Solutions and recommendations

The market intelligence team at Infiniti Research provide solutions on health economics optimization, helping stakeholders to apprehend product value and its potential in the healthcare sector. Some of the solutions are listed below:

  • Create a database that shows clinical statistics on the incidence rates of disease such as lung cancer, breast cancer, coronary artery disease, prostate cancer, structural heart disease, and stroke
  • Provide insights on the average reimbursement rate for each procedure/diagnostic test through robust insurance practices such as statutory health insurance (outpatient), statutory health insurance (inpatient), and private health insurance
  • Validate the existing demand-supply gap and allocate the resources according to the specific requirements
  • Deliver a reasonable understanding of the demand-supply gap analysis and find measures to curb the gap

Read our comprehensive case study on how we helped a leading laboratory diagnostics company derive health economics data


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Health Economics for Medical Device Developers

The medical device industry is driven by optimistic device companies in the U.S., Europe, and Asia that seek innovation. With new innovations, the key stakeholders in the medical device market will keep funding research and new ideologies to bring about product differentiation. From the demand for self-medication to in-home healthcare services, the medical device industry is witnessing a change in preferences. Currently, the industry is going through a huge strategic change with respect to the development and launch of new products. And our health economists are here to help decode the trends for all the medical device developers.

Health economics plays a vital role in demonstrating the value of new products launched by medical device manufacturers. In general, there are two main areas to focus – Medical Device Reimbursement and Market Access. Involving health economics early in the process will help businesses assess product development opportunities. At Infiniti Research, our experts will leave you with compelling reasons to choose health economics for the medical device industry.

Let Data Do the Talking

Create a comprehensive reimbursement plan for medical devices with the help of health economics analysis from a payers’ perspective. A detailed health economics analysis will give you insights on providing quality care for more people by reducing costs. This will help decision makers to conclude how effective the proposed medical device is over the existing ones and its value for money. This will also prevent the development of technologies and devices that have doubtful value in the future.

Make Well-informed Decisions

Expenditure in the medical device industry is substantially growing. There is an extensive government intervention when it comes to norms and regulations to promote the efficient use of medical devices. This is where an economic evaluation of medical devices will keep every medical device manufacturer informed about the pricing and reimbursement plans. Not just that, it will demonstrate the cost-effectiveness of new and emerging medical devices to make sound decisions.

Rethink Reimbursement

Cost-effectiveness of medical devices plays a huge role when it comes to reimbursement. If there exists therapy A and a new therapy B and they both seem to have similar clinical outcomes, preference will be given to the therapy that is more cost efficient. However, this choice of treatment can be debated if therapy B is much more effective than A. As a medical device manufacturer, you can save time and money when you rethink reimbursement.

As a medical device manufacturer, it is a wise choice to analyze the health economics for the newly developed medical device. Right from assessing the commercial viability of the device to avoiding frugal innovations, the device will have its reimbursement strategies explored. Other than that, a developer can make a better, informed product design ruling out unpromising technologies.

Whether you’re a strategy expert or a decision maker, here is our case study.

Medical Reimbursement, Health Economics, and Market Access Mapping for Wound Care Dressings.
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Medical Reimbursement, Health Economics, and Market Access Mapping for Wound Care Dressings

Limitations of the Fee-for-Service (FFS) medical reimbursement model and arrival of Value-based Purchasing (VBP) pose a significant challenge for medical device manufacturers and service providers looking to enter the medical reimbursement market space.


Despite being an integral part of every nation’s well-being, rising costs are putting a strain on the healthcare system and threaten to restrict doctors from providing their patients with the best care possible. With high levels of national debt and rising geriatric population, governments from across the globe are well aware of the steps that have to be taken to reduce the rising cost of healthcare expenses while retaining and ameliorating the quality of patients’ care. Medical reimbursement is a big part of this picture and continues to alter the methods of care. Limitations of the FFS medical reimbursement model and the arrival of VBP medical reimbursement are some of the key challenges faced by professionals looking to enter the reimbursement market space. Furthermore, with the growing preference for Value-based Care among payers and providers, they will continue to navigate between new and old ways of providing high-quality patient care, while keeping an eye on cost.

Over the years, reimbursement for medical device segment has utilized a variety of payment mechanisms withcapture varying degrees of effectiveness. However, whether these mechanisms are used individually or in combination, it is crucial that the resulting systems remunerate on the basis of complexity, quantity, and quality of care provided. Consequently, it becomes crucial for a medical device company to obtain coverage and attract risk-averse investors. Also, factors like whether a device is reimbursable or not and costs associated with reimbursement are key factors that determine a product’s demand and its commercial success.

At Infiniti, our “Healthcare Practice” team understands that reimbursement is an integral part of developing and marketing a medical device and is a key enabler for strategies adopted by companies looking to derive maximum returns from the success of their products in the market. Key components which our “healthcare analysts” cover include coverage, coding, and payment as those are considered pertinent for obtaining adequate reimbursement in today’s competitive healthcare market space.

The Business Challenge

To assess the dynamic medical reimbursement landscape and understand the costs associated with healthcare reimbursement, a world leading manufacturer of wound care and single-use surgical products engaged Infiniti for a study focused on understanding the wound care dressings reimbursement market in China and Japan.

The primary goal of this market opportunity assessment was to develop a comprehensive understanding of thecapture2 wound care dressing reimbursement market structure, price caps, regulatory compliances, the impact of the regulatory compliances on product prices, and medical reimbursement figures for wound care dressing products across the target countries. Additionally, this client also wanted to obtain critical insights into medical device funding and reimbursement pathways for wound care dressings product in China and Japan.

Infiniti’s healthcare practice team tracked recent developments and innovations in the market through secondary journals and reached out to relevant stakeholders, including industry experts, KOLs, product users, and procurement experts, to understand their views on the market. Our healthcare research team also spoke to stakeholders responsible for the sales and distribution of these products to understand how the market would grow in short and long term and also to validate the market size and opportunity model developed for this segment.

Why Infiniti Research is the preferred partner for more than 55 Fortune 500 Companies


Solution Offered and Business Impact

By evaluating a wide array of published literature to develop an initial hypothesis, Infiniti’s healthcare intelligence team offered the client insights into the medical reimbursement market for their product, recent changes in reimbursement policies, and an analysis of regulations specific to the product’s reimbursement. The market opportunity assessment also helped the business understand the market structure, price caps, regulatory compliances, impact of the regulatory compliances on product prices, and reimbursement figures for its products across target regions.

In just nine weeks, our healthcare industry intelligence team helped the client understand reimbursement pathways for wound care dressings products and gain strategic insights for its wound care dressing products in China and Japan.

To assess the challenges specific to the medical reimbursement sector, Infiniti’s healthcare analysts have developed an extensive proprietary database consisting of information on more than two million industry experts, doctors, physicians, key opinion leaders, medical technicians, payers, end-users, and patients.

What do the clients appreciate about our approach?

In a relatively short period of time, just nine weeks, the client saw clear benefits from our relationship. The benefit was not only in terms of revenue impact or analytics turnaround time but also in terms of the experience we were staging for them by exposing them to a new way of problem-solving.

Here are some of the key points appreciated by our clients:


  • Dedicated Market Intelligence Portal. A centralized platform for the collection, storing, processing, reporting, and dissemination of information with the specific purpose of assisting the decision-making process and developing actionable insights. This portal includes comprehensive information on quantitative and qualitative aspects on target markets, competitors and end-users.
  • Collaborative learning. We leveraged experience of our healthcare team and our technical capabilities to enable report-sharing and other collaborative features appreciated by client teams.
  • Database Access. Access to a patient database containing information about 60+ medical diseases and conditions, such as patient undergoing treatment, untreated patients, and patients with chronic conditions.
  • Interactive Dashboard. Using our Portal based solution for healthcare professionals, we took a design-first approach to problem solving and helped break through previously held assertions.
  • Value for Money. Infiniti’s dedicated client management team customizes reports to suit business requirements and offers the best insights for every dollar spent.


A must-read case study for strategy experts and decision makers looking for effective market opportunity assessment for the healthcare reimbursement landscape.


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