Negotiating pricing and payment terms for insurance covered mHealth apps: a qualitative content analysis and taxonomy development based on a German experience.

IF 2.7 3区 经济学 Q1 ECONOMICS
Bettina Freitag, Leonard Fehring, Marie Uncovska, Alexandra Olsacher, Sven Meister
{"title":"Negotiating pricing and payment terms for insurance covered mHealth apps: a qualitative content analysis and taxonomy development based on a German experience.","authors":"Bettina Freitag, Leonard Fehring, Marie Uncovska, Alexandra Olsacher, Sven Meister","doi":"10.1186/s13561-024-00558-8","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Germany was the first country worldwide to offer mobile digital health applications (mHealth apps, \"DiGA\") on prescription with full cost coverage by statutory health insurances. Especially statutory health insurances criticize the current pricing and payment regulations in Germany due to \"free and non-transparent\" pricing in the first year and lack of cost use evidence. The study consists of two parts: The first part evaluates interests of digital health application providers and statutory health insurances in Germany to identify overlaps and divergences of interests. The second part includes the development of a comprehensive pricing and payment taxonomy for reimbursable mHealth apps in general.</p><p><strong>Methods: </strong>Both parts of the study used the input from 16 expert interviews with representatives of digital health application providers and statutory health insurances in Germany. In part one the authors conducted a qualitative content analysis and in part two they followed the taxonomy development process according to Nickerson et al. (2013).</p><p><strong>Results: </strong>A value based care model is expected to bring the greatest benefit for patients while statutory health insurances welcome the idea of usage based pricing. The final pricing and payment taxonomy consists of four design and negotiation steps (price finding, payment prerequisites, payment modalities, composition of negotiation board).</p><p><strong>Conclusions: </strong>As healthcare resources are scarce and thus need to be optimally allocated, it is important to implement pricing and payment terms for reimbursable mHealth apps that result in the greatest benefit for patients. To the best of the authors' knowledge, there has been no structured study yet that examines alternative pricing strategies for reimbursable mHealth apps.The developed pricing and payment taxonomy for reimbursable mHealth apps serves as planning and decision basis for developers, health policy makers and payers internationally.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":"14 1","pages":"81"},"PeriodicalIF":2.7000,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11451222/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Health Economics Review","FirstCategoryId":"96","ListUrlMain":"https://doi.org/10.1186/s13561-024-00558-8","RegionNum":3,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ECONOMICS","Score":null,"Total":0}
引用次数: 0

Abstract

Background: Germany was the first country worldwide to offer mobile digital health applications (mHealth apps, "DiGA") on prescription with full cost coverage by statutory health insurances. Especially statutory health insurances criticize the current pricing and payment regulations in Germany due to "free and non-transparent" pricing in the first year and lack of cost use evidence. The study consists of two parts: The first part evaluates interests of digital health application providers and statutory health insurances in Germany to identify overlaps and divergences of interests. The second part includes the development of a comprehensive pricing and payment taxonomy for reimbursable mHealth apps in general.

Methods: Both parts of the study used the input from 16 expert interviews with representatives of digital health application providers and statutory health insurances in Germany. In part one the authors conducted a qualitative content analysis and in part two they followed the taxonomy development process according to Nickerson et al. (2013).

Results: A value based care model is expected to bring the greatest benefit for patients while statutory health insurances welcome the idea of usage based pricing. The final pricing and payment taxonomy consists of four design and negotiation steps (price finding, payment prerequisites, payment modalities, composition of negotiation board).

Conclusions: As healthcare resources are scarce and thus need to be optimally allocated, it is important to implement pricing and payment terms for reimbursable mHealth apps that result in the greatest benefit for patients. To the best of the authors' knowledge, there has been no structured study yet that examines alternative pricing strategies for reimbursable mHealth apps.The developed pricing and payment taxonomy for reimbursable mHealth apps serves as planning and decision basis for developers, health policy makers and payers internationally.

就保险范围内的移动医疗应用程序的定价和支付条款进行谈判:基于德国经验的定性内容分析和分类开发。
背景:德国是世界上第一个根据处方提供移动数字医疗应用程序(移动医疗应用程序,"DiGA")并由法定医疗保险承担全部费用的国家。由于第一年的定价 "免费且不透明 "以及缺乏成本使用证据,法定医疗保险机构尤其对德国现行的定价和支付规定提出了批评。本研究由两部分组成:第一部分评估了德国数字医疗应用提供商和法定医疗保险机构的利益,以确定利益的重叠和分歧。第二部分包括为可报销的移动医疗应用程序制定全面的定价和支付分类标准:研究的两个部分都采用了 16 次专家访谈的结果,访谈对象包括德国数字医疗应用程序提供商和法定医疗保险机构的代表。在第一部分中,作者进行了定性内容分析,在第二部分中,作者按照尼克森等人(2013 年)的分类法开发流程进行了分析:结果:以价值为基础的医疗模式有望为患者带来最大利益,而法定医疗保险机构则欢迎以使用为基础的定价理念。最终的定价和支付分类法包括四个设计和谈判步骤(价格发现、支付前提、支付模式、谈判委员会的组成):由于医疗资源稀缺,因此需要进行优化分配,对可报销的移动医疗应用程序实施定价和支付条款,为患者带来最大利益是非常重要的。据作者所知,目前还没有结构化研究对可报销移动医疗应用程序的替代定价策略进行研究。所开发的可报销移动医疗应用程序定价和支付分类法可作为国际开发商、卫生政策制定者和支付者的规划和决策依据。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
CiteScore
3.90
自引率
4.20%
发文量
59
审稿时长
13 weeks
期刊介绍: Health Economics Review is an international high-quality journal covering all fields of Health Economics. A broad range of theoretical contributions, empirical studies and analyses of health policy with a health economic focus will be considered for publication. Its scope includes macro- and microeconomics of health care financing, health insurance and reimbursement as well as health economic evaluation, health services research and health policy analysis. Further research topics are the individual and institutional aspects of health care management and the growing importance of health care in developing countries.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信