Reimbursement decisions for medical services in Austria: an analysis of influencing factors for the hospital individual services catalogue between 2008 and 2020

Objectives To (1) describe the (evidence-based) reimbursement process of hospital individual services, (2) evaluate the accordance between evidence-based recommendations and reimbursement decision of individual services and (3) elaborate potential aspects that play a role in the decision-making proc...

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Vydáno v:BMC health services research Ročník 22; číslo 1; s. 205 - 13
Hlavní autoři: Goetz, Gregor, Panteli, Dimitra, Busse, Reinhard, Wild, Claudia
Médium: Journal Article
Jazyk:angličtina
Vydáno: London BioMed Central 15.02.2022
BioMed Central Ltd
Springer Nature B.V
BMC
Témata:
Austria
Belgium
Benefit catalogue
Committees
Content analysis
Cost-Benefit Analysis
Coverage
COVID-19
Decision making
Economic aspects
Focus groups
Health Administration
Health Informatics
Health insurance
Health services
Health technology assessment
Hospitals
Humans
Interdisciplinary aspects
Management
Medical care
Medical equipment
Medicine
Medicine & Public Health
Nursing Research
Pandemics
Public Health
Reimbursement
SARS-CoV-2
Services
Social aspects
Austria
Belgium
Europe
Benefit catalogue
Coverage
Reimbursement
ISSN:1472-6963, 1472-6963
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Shrnutí:Objectives To (1) describe the (evidence-based) reimbursement process of hospital individual services, (2) evaluate the accordance between evidence-based recommendations and reimbursement decision of individual services and (3) elaborate potential aspects that play a role in the decision-making process in Austria. Method The reimbursement process is described based on selected relevant sources such as official documents. Evidence-based recommendations and subsequent reimbursement decisions for the annual maintenance of the hospital individual service catalogue in Austria between 2008 and 2020 were analysed using a mixed methods approach, encompassing descriptive statistics and a focus group with Austrian decision makers. Results 118 evidence-based recommendations were analysed. There were 93 (78.8%) negative and 25 (21.2%) positive evidence-based recommendations. In total, 107 out of 118 evidence-based recommendations (90.1%) did not lead to a deviating reimbursement decision. We identified six aspects that may have played a role in the decision-making process for the annual maintenance of the hospital individual service catalogue, with clinical evidence being the most notable. Further aspects included quality assurance/organisational aspects (i.e., structural quality assurance), costs (if comparable to already existing medical services, not: cost-effectiveness), procedural aspects (e.g., if certain criteria for adoption have not been met formally through the proposals), “other countries” (i.e., taking into account how other countries decided) and situational aspects (such as the COVID-19 pandemic). Conclusions There is good accordance between evidence-based recommendations and reimbursement decisions regarding hospital individual services in Austria. Beyond clinical evidence, organisational aspects seem to be considered often with regard to quality assurance but costs do not appear to play a major role. The Austrian system has mechanisms in place that can restrict widespread adoption of novel hospital individual services with uncertain clinical benefits. Future studies could investigate how well these mechanisms work and how they compare to other health systems in Europe.
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ISSN:1472-6963
1472-6963
DOI:10.1186/s12913-022-07531-3