Medical device reimbursement is the payment made by a third party private or public insurer to a health care provider in exchange for the costs or payments incurred by the provider for performing the required procedure or using a medical device. There are three goals for any medical device reimbursement strategy, universal coverage from all insurers in all patient care settings, adequate physician and institutional reimbursement, and unambiguous coding. Reimbursement is the primary issue on every investor’s mind, and it is one of the first things healthcare companies think about when developing new products or medical devices. If the coverage under medical device reimbursement has no certainties, it becomes very difficult for companies to analyze the return on investment. This obstructs venture funding and also limits innovation. Consequently, it pulls back the patients from leveraging the benefits of advanced and new technologies. Thus, medical device reimbursement and coverage of payers play a very important role in making or breaking a medical device. There are several challenges associated with medical device reimbursement for manufacturers, which varies from countries to countries. In this article, we have listed down some of the most common challenges that every manufacturer faces in medical device reimbursement. Also, we have suggested a few solutions to deal with those challenges.

Medical Device Reimbursement Challenges

Misalignment of reimbursement rates and the value of medical technologies 

There are many countries where rates of medical device reimbursement are based on standing formulas that are applied to procedure or types of device and not on the technology or features of the individual manufacturer. This prevents companies from investing in advanced technologies that can help in reducing costs in the long run and improve the outcome.

Limited spending on medical device reimbursement by the government

With the expansion of the aging population in countries like U.S.A, Japan, China, and E.U, governments across the globe keep looking for ways to cut down their spending on medical device reimbursement. This prevents their overall healthcare spending. This, in turn, is a setback for manufacturers who are looking to invest in manufacturing advanced medical devices.

Opaque medical device reimbursement process

The medical device reimbursement process is probably one of the most complex and opaque processes that stop innovations in medical devices. There are many stakeholders involved in the process in many countries who interact with manufacturing companies. Many times, reimbursement decisions can be uncertain, lengthy, and opaque. This is one of the significant challenges that manufacturers face in many countries.

Infiniti’s Advantage

Infiniti Research’s specialized market intelligence services include patient pathways, market access, and healthcare and reimbursement landscape to help healthcare payers and providers understand and analyze the current medical device reimbursement pathways, policies, and the quickly evolving landscape of the specialized healthcare industry. With the growing incidence of complications in healthcare, especially among the elderly population, the demand for medical devices that help deal with such conditions has increased. At Infiniti, we help companies gain detailed insights into the latest reimbursement policies to help medical device manufacturers identify challenges and opportunities prevailing in the healthcare industry. Our reimbursement solutions leverage a better understanding of the evolving trends in the healthcare industry and actionable insights into the regulatory, demographic, and healthcare infrastructure.

Are you looking for solutions to any of these challenges or want to gain more insights into our health plan and payer services? Get in touch today!