Key topics
There is only one key theme describing market access for medical technologies in Austria:
Reimbursement: payment via DRG-adjusted budget.
There are no separate funding (approval by the payer) or health technology assessment challenges in Austria. HTA (by the Austrian Institute for Health Technology Assessment) is integrated into reimbursement decision-making.
Austria has one innovative payment scheme for medical technologies (NUB, provisional coding for medical procedures).
Reimbursement
Austrian hospitals are funded using a budget adjusted for activity based on DRGs.
DRGs are defined by a combination of:
- Diagnosis codes (International Classification of Diseases; ICD-10)
- Procedure codes (Austrian Individual medical procedure; MEL)
- Patient-specific parameters (e.g., age, length of stay, sex)
The combination of codes and patient characteristics will result in a specific DRG associated with points (cost weight). These DRG points are multiplied with a monetary base rate that differs between states and even hospitals within states. Cost weights are determined on the basis of the micro-costing method using data from selected reference hospitals.
There is no add-on reimbursement for medical devices or procedures.
Innovative procedures with insufficient clinical evidence to justify the creation of the regular procedure (MEL) code can receive registration as provisional procedure codes (NUB). Provisional procedure codes do not attract additional or higher reimbursement vs standard treatment.
An updated version of the LKF catalog is released by the Federal Ministry of Social Affairs, Health, Care, and Consumer Protection annually. It comes into effect on January 1st of each calendar year.
Specifics for IVD tests
There is no specific reimbursement framework for in-vitro diagnostic tests, which are performed within specialist care settings. Most IVD tests are funded using a global budget principle as part of the funding of the labs.
Simple IVD tests, which can be ordered by primary care physicians, can be reimbursed via fee schedules, developed by individual sickness funds.
How can MTRC help?
Development of reimbursement analysis (procedure coding, payment mechanism, reimbursement tariffs, policy and HTA considerations)
Development of reimbursement strategy
Adaptation of the global health economic model to the Austrian settings
Access to an educational seminar on the Austrian reimbursement system
MTRC has experience with more than 115 projects in Austria
Get in touch
Contact us to discuss your needs and learn about our services