There is only one key theme describing market access for medical technologies in Portugal:
- Reimbursement: payment mechanism via the global budget adjust for DRGs (hospital services) and actual hospital outpatient volume (fee-for-service tariffs), separately accounted devices
Hospital care is predominantly funded via a global budget mechanism, with budgets being based on the previous year’s figures, adjusted for DRG case-mix data reported by the hospitals (hospital admitted settings) and actual non-adjusted hospital outpatient volume (day case and outpatient specialist services with fee-for-service tariffs).
DRGs are determined by the combination of a procedure code (ICD-10-PCS) and a diagnosis code (ICD-10-CM). Portugal uses the the APR-DRG system v31 from 2013, and it is not possible to update the DRG system, nor the procedural classification (adopted annually from Centers for Medicare and Medicaid, CMS).
The Central Administration of the Health System (ACSS) maintains the DRG system and the procedural classification. DRG relative weights (and tariffs) are determined by the Ministry of Health and are listed in Ordinance 207/2017, commonly known as the “Portaria”.
The “Portaria” also defines the list of certain high cost devices, the costs of which are not included in the DRGs for the procedure and must be accounted for on top of the DRG.
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.
However, the existing reimbursement codes and their tariffs listed in Annex IV of the “Portaria” are used to calculate laboratories’ budgets, but for are also used for between-laboratory billing.
How can MTRC help?
Development of reimbursement analysis (procedure coding, payment mechanism, reimbursement tariffs, policy and HTA considerations)
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