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 reimbursement for manufacturers, which vary from country to country. In this article, we have listed down some of the most common challenges. 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 reimbursement are based on standing formulas that are applied to procedures or types of devices 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 the U.S.A, Japan, China, and the E.U, governments across the globe keep looking for ways to cut down their spending. This prevents their overall healthcare spending. This, in turn, is a setback for manufacturers who are looking to invest in manufacturing advanced medical devices.
The 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 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!