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

Health Care Financing,
Journal Articles

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

By: Ildikó Ádám, Marcelien Callenbach, Bertalan Németh, Rick A Vreman, Cecilia Tollin, Johan Pontén, Dalia Dawoud, Jamie Elvidge, Nick Crabb, Sahar Barjesteh van Waalwijk van Doorn-Khosrovani, Anke Pisters-van Roy, Áron Vincziczki, Emad Almomani, Maja Vajagic, Z Gulsen Oner, Mirna Matni, Jurij Fürst, Rabia Kahveci, Wim G Goettsch, Zoltán Kaló

Publication: Frontiers in Medicine; 23 September 2022; DOI: https://doi.org/10.3389/fmed.2022.940886


Outcome-based reimbursement models can effectively reduce the financial risk to health care payers in cases when there is important uncertainty or heterogeneity regarding the clinical value of health technologies. Still, health care payers in lower income countries rely mainly on financial based agreements to manage uncertainties associated with new therapies.

The authors performed a survey, an exploratory literature review and an iterative brainstorming in parallel about potential barriers and solutions to outcome-based agreements in Central and Eastern Europe (CEE) and in the Middle East (ME). A draft list of recommendations deriving from these steps was validated in a follow-up workshop with payer experts from these regions. Twenty different barriers were identified in five groups, including transaction costs and administrative burden, measurement issues, information technology and data infrastructure, governance, and perverse policy outcomes. Though implementing outcome-based reimbursement models is challenging, especially in lower income countries, those challenges can be mitigated by conducting pilot agreements and preparing for predictable barriers. This guidance paper provides an initial step in this process. The generalizability of the authors’ recommendations can be improved by monitoring experiences from pilot reimbursement models in CEE and ME countries and continuing the multi-stakeholder dialogue at national levels.