Innovative payment schemes

On November 17, 2024, the French Ministry of Health and Access to Care published an Order in the Official Journal of the French Republic on the support and reimbursement of reinforced care pathways – a direct outcome of the experimental projects under Article 51 of the Social Security Financing Act of 2018, which aimed to innovate healthcare delivery and financing models. The new framework aims to enhance the coordination and quality of care for patients with complex health needs and provides financing for coordinated care projects.

In October 2024, the Ministry of Health, Welfare, and Sport decided to discontinue the "Subsidy scheme for promising care," which was implemented in 2019 to support the development of missing clinical and economic evidence for promising care that otherwise cannot be covered within basic health insurance. There are 28 ongoing projects, and some new projects will be awarded the subsidy in the 2025 round.

On October 14, 2024, the Institute for the Hospital Remuneration System (InEK) published the DRG catalog (Fallpauschalen-Katalog) with the list of DRGs and additional reimbursement categories (ZEs) for 2025. Three new DRGs were introduced in the endoscopy and ophthalmology fields.

On September 2, 2024, the Institute for Hospital Remuneration Systems (INeK) announced the start of the application process according to §6 (2) KHEntgG (New Examination and Treatment Methods, NUB) for 2025.

On April 25, 2024, the Ministry of Labor, Health, and Solidarity published an Order in the Official Journal of the French Republic setting the tariffs for digital medical devices with therapeutic functions covered within the early digital support (PECAN) scheme. The tariff for the manufacturer will include an initial lump sum of €435 per patient billable for up to 3 months and a subsequent monthly package of €38.30. The maximum amount of financial compensation is €780 per year per patient.

On September 1, 2023, the Institute for Hospital Remuneration Systems (INeK) announced the start of the application process for the innovation funding of the new examination and treatment methods (NUB) for 2024. The Federal Joint Committee (G-BA) reminds applying hospitals about minor changes in application requirements.

At early September 2023, the new version of the classification of procedure codes (CCAM v.73) was published. Several changes were introduced, including the creation of two permanent codes, one provisionally registered code, and three new grouping codes for 280 dental procedures.

On June 7, 2023, the Innovation Committee at the Federal Joint Committee (G-BA) published the overview of thirty-five newly funded healthcare research projects. These projects relate to the two funding announcements of June 27, 2022 (changed on September 20, 2022).

Director of MTRC Oleg Borisenko participated in the session “Innovative Payment Schemes (IPSs) in Europe: springboard for innovation?” at the Med Tech Forum in Dublin on the 31st of May 2023. The section was moderated by Rachele Busca (Director, HTA and Real-World Evidence, EMEACLA, Edwards Lifesciences) and panelists included Daniel Bamford (Deputy Director, Medtech and Digital, Innovation, Research and Life Sciences, NHS England) and Louisa Stüwe (Ministerial eHealth Delegation, Ministry of Health and Prevention, France). Oleg presented the summary of the report on innovative payment schemes for medical technologies, commissioned in 2022 by the European industry association Med Tech Europe to MTRC. We present a summary of the presentation.

On March 31, 2023, the Ministry of Health and Prevention published the Decree in the Official Journal of the French Republic that defines an application process for the early coverage of digital medical devices for therapeutic purposes and medical telemonitoring by health insurance.

In March 2023, the Dutch Healthcare Institute (Zorginstituut Nederland, ZIN) announced two more projects which received a subsidy under the "Subsidy scheme for promising care" in 2023 for research of focal therapy in intermediate risk prostate cancer and repetitive transcranial magnetic stimulation in paresis due to the cerebral infarction or cerebral hemorrhage.

On March 8, 2023, the Ministry of Health and Prevention published an Order in the Official Journal of the French Republic on the coverage of the INTERVAPOR system for lung volume reduction under Forfait innovation program.