There are two key themes describing market access for medical technologies in Ireland:
- Reimbursement: payment mechanism via the DRG-adjusted budget system, block grants
- Health technology assessment: obtaining recommendations from the Health Information and Quality Authority (HIQA)
Hospital care is financed via a budget mechanism, adjusted for activities on the basis of DRGs.
DRGs are determined by the combination of a procedure code and a diagnosis code. Ireland uses Australian coding classifications (Australian Classification of Health Interventions, ICD-10-AM) and the DRG system (AR-DRG). However, the coding standards are adapted to the Irish setting and are being updated annually.
The Healthcare Pricing Office (HPO) collects the case-mix data reported by the hospitals, adjusts the DRG tariffs annually, and maintains the DRG system in general.
However, as the block grant payment model was historically dominant and still has a certain role (in 2022, 32% of all hospital funding was still via block grant), and due to the fact that it is not possible to introduce new procedure codes/adjust the DRG system in Ireland, adoption by healthcare providers can be considered the key market access goal.
Health technology assessment
HTAs are performed on the national level by the Health Information and Quality Authority, and their recommendations influence the adoption of novel technologies by healthcare providers.
Specifics for IVD tests
There is no specific reimbursement framework for in-vitro diagnostic tests. IVD tests are funded using a global budget principle as part of the laboratory funding.
How can MTRC help?
Development of reimbursement analysis (procedure coding, payment mechanism, reimbursement tariffs, policy and HTA considerations)
Get in touch
Contact us to discuss your needs and learn about our services