A new study has found that telemedicine, remote monitoring, mobile health apps, and other tools designed to improve patient care or streamline administrative processes are more likely to be rapidly adopted in the health sector when there are clear pricing strategies and well-structured reimbursement methods in place. Reimbursing health-care providers for the use of digital health solutions is key to promoting patients’ access to these tools, reducing costs for providers and patients.
The study, “Digital health reimbursement strategies of 8 European countries and Israel: scoping review and policy mapping”, led by the Department of Health Policy at the London School of Economics and Political Science (LSE) and supported by WHO/Europe, investigated whether digital health is a reimbursable form of health care in Belgium, France, Germany, Israel, Italy, the Netherlands, Poland, Sweden and the United Kingdom. The authors also analysed reimbursement mechanisms, pricing of digital health solutions, and the funding to reimburse these solutions outside of insurance policies.
"The findings show us that, when designed properly, digital tools can go a long way in promoting people’s health and improving health outcomes,” explained Dr David Novillo Ortiz, WHO/Europe’s Regional Adviser on Data and Digital Health and one of the co-authors of the study. “Second, and crucially, they show that any meaningful step toward universal health coverage should include digital health tools, also by designing reimbursement policies that promote their use while minimizing financial costs.”
Affordability is key
Although they have great potential, digital health solutions don't always fit into established funding structures, which tend to focus on services, medicines and diagnostics. This can be a major obstacle for health-care facilities aspiring to adopt a wide range of digital tools and services.
The COVID-19 pandemic accelerated the digital transformation of the health-care sector, leveraging the power of technology to manage and treat diseases, although uptake in practice has been met with numerous difficulties – especially for marginalized communities. To improve health-care accessibility during the pandemic, authorities in some countries reimbursed health-care providers for delivering inclusive services through telehealth or mHealth apps.
Dr Robin Van Kessel, Senior Health Policy Research Associate at LSE and the lead author of the study, said: “The uptake of digital health solutions is complex and depends on many factors, such as affordability and trust. Including digital health in reimbursement structures is the first step to provide important financial support for innovation and signal to users and health-care providers that the technology has been robustly assessed. Once this step is taken and digital health is being used at scale, we can start having an honest discussion about the value and utility of digital health, which can inform more sophisticated, value-based reimbursement mechanisms.”
Disparities in pricing and reimbursement
The study shows that that digital health solutions are generally reimbursable in all researched countries, with the notable exception of Poland. At the same time, the wide variety of approaches and reimbursement methods may create challenges for patients seeking health care abroad. Similarly, the fragmented environment creates issues for developers of such solutions, as they look to expand their impact across countries.
Almost all researched countries have adopted a system in which the price of digital solutions is determined through negotiations between national or regional committees and manufacturers. This is what is often referred to as “cost-based” pricing.
On the other hand, “value-based” pricing is when the price is based on the value that an intervention adds to the health-care process, such as improved health outcomes or reduced costs. The study shows that this could be a promising solution to optimize the allocation of funds and tackle challenges faced by health systems.
“Disparities in pricing and reimbursement could stem from the innovative and unprecedented nature of digital health, coupled with resistance to change in the health-care sector,” said Dr Novillo Ortiz. “We must continue working to improve digital health literacy among not just health professionals, but also policy-makers and patients.”
Moving forward
To ensure sustainable digital health integration and financing in the countries studied, the authors recommend developing a comprehensive, value-based framework for the assessment of digital health solutions.
In its 2023 report, “Digital health in the European Region: the ongoing journey to commitment and transformation”, WHO/Europe calls for urgent investment, robust financing strategies, and strong collaboration between Member States. Governments and health authorities working together with the public and private sectors can remove funding barriers and speed up the adoption of inclusive digital health strategies.
If you would like to know more about this study, please reach out to the Data and Digital Health Unit at the WHO Regional Office for Europe at EUDigitalHealth@who.int