Delayed payment schemes in Central-Eastern Europe and Middle-East

Abstract

The need for innovative payment models for health technologies with high upfront costs has emerged due to affordability concerns across the world. Early technology adopter countries have been experimenting with delayed payment schemes. Our objective included listing potential barriers for implementing delayed payment models and recommendations on how to address these barriers in lower income countries of Central and Eastern Europe (CEE) and the Middle East (ME). We conducted a survey, an exploratory literature review and an iterative brainstorming about potential barriers and solutions to implement delayed payment models in these two regions. A draft list of recommendations was validated in a virtual workshop with payer experts from the two regions. Eight barriers were identified in 4 areas, including transaction costs and administrative burden, payment schedule, information technology and data infrastructure, and governance. Fifteen practical recommendations were prepared to address these barriers, including recommendations that are specific to lower income countries, and recommendations that can be applied more universally, but are more crucial in countries with severe budget constraints. Conclusions of this policy research can be considered as an initial step in a multistakeholder dialogue about implementing delayed payment schemes in CEE and ME countries.

When Reality Does Not Meet Expectations—Experiences and Perceived Attitudes of Dutch Stakeholders Regarding Payment and Reimbursement Models for High-Priced Hospital Drugs

“…Outcome-based reimbursement models and delayed payments models are seen as promising alternatives to reduce remaining (clinical) uncertainties, diminish the budget impact, share financial risks, and improve/ensure patient access [21,52,53]. Nonetheless, it is still debated how much is and can be gained with the implementation of outcome-based reimbursement and delayed payment models due to their complexity and administrative burden [27][28][29][30][31][32]54]. The perceived barriers stakeholders expressed when implementing the preferred outcome-based reimbursement and delayed payment models clarify why the preferred models are currently not yet commonly applied in the Netherlands.…”

“…Correspondingly, the main reason why discounts and upfront payments are experienced best according to the respondents, namely the simplicity of these agreements, can be explained. Some of the described barriers perceived were also more broadly experienced across Europe and the United States [7,16,27,28,31,32,36,52,54]. Bohm et al presented a clear overview of the main challenges related to successfully implementing outcome-based agreements across Europe, namely the lack of useful negotiation frameworks; difficulties in determining outcomes; the burden of data administration and implementation; and laws and regulation [22].…”

Outcome-based reimbursement in Central-Eastern Europe and Middle-East

“…The final outcome of the research carried out by the HTx team was a list of barriers and potential solutions for outcomebased reimbursement models, based on a consensus among the research team and workshop participants. In the course of this project, list of barriers and recommendations for implementing delayed payment schemes were also described in a separate manuscript (24).…”

Pricing and reimbursement mechanisms for advanced therapy medicinal products in 20 countries

“…Payers handling the difficult task of managing financial risk and uncertain evidence, where it exists, need to embed risk management strategies into their pricing and reimbursement (P&R) decision making processes, and they often do so through special pricing mechanisms ( Hanna et al, 2018 ; Gonçalves, 2021 ; Jørgensen and Kefalas, 2021 ). While there are many theoretical papers on P&R options ( Carr and Bradshaw, 2016 ; Godman et al, 2018 ; Gonçalves, 2021 ; Ádám et al, 2022 ), original empirical research is very scarce. The Organization for Economic Co-operation and Development (OECD) conducted a survey of experts on the use of managed entry agreements (MEA) in 12 countries ( Wenzl and Chapman, 2019 ) but did not deal with specific therapies.…”