The funding reflects a willingness to pay for procedure or device by payers. Funding is different from reimbursement, which is the method to pay for the procedure (e.g. via diagnosis-related group).
The procedure can have a procedure code and be grouped into DRG with sufficient tariff, but payers do not want to pay for the procedure, which results in this procedure not having coverage in the target country. This is the case, for example, for robotic surgery in England. Robotic surgery is approved for funding by NHS England for some indications (e.g. prostatectomy) and not approved for others (e.g. bladder cancer).
Therefore, the funding represents the unique market access challenge, which should be well understood. Explicit funding frameworks exist in England, Germany, the Netherlands, Norway, and Switzerland.
MTRC released a report on funding decisions by payers for medical technologies in Europe:
- England: All commissioning policies by NHS England for nationally commissioned procedures; procedures from the List of restricted technologies from one Clinical Commissioning Group - North Staffordshire CCG. Service specifications are not included
- Germany: Technologies included into G-BA Directives for hospital care
- Netherlands: Decisions about coverage of procedures in the Basic Health Insurance by the Dutch Health Care Institute (Zorginstituut Nederland)
- Norway: Decisions of the Decision Forum of the "New Methods" framework
- Switzerland: Decisions about coverage of services within statutory health insurance by the Federal Office of Public Health
Key features of the report:
- Devices, procedures and IVD tests - Data about all non-drug decisions are included into the report
- Overview of funding frameworks - Brief overview of each funding framework is provided
- Key information and summary statistics - For each report, information about type of technology (e.g. neurostimulator, cardiovascular) and decisions (positive or negative) is included. Summary statistics is provided
- List of all published decisions (>1000) - All decisions per country/organization are listed in the table format including organization, title, type of technology, decision and web-link. Optionally, access the full list in MS Excel
You can download sample pages and order the report here.