Reimbursement

On September 16, 2024, the National Association of Statutory Health Insurance Physicians (KBV) and the National Association of Statutory Health Insurance Funds (GKV-Spitzenverband) announced that they had reached an agreement in financing negotiations concerning outpatient care.

The French National Authority for Health (HAS) released new recommendations about add-on reimbursement of medical devices and medical aids from the meetings of the National Commission for Evaluation of Medical Devices and Health Technologies (CNEDiMTS) in September 2024. Five recommendations were published concerning the registration or modification of registration conditions/extension of indications for the medical devices in the List of Reimbursable Products and Services (LPPR). Opinions concern endocrine and spine devices, as well as medical aids.

On September 18, 2024, the Organization for Outpatient Physician Tariffs (OAAT) AG announced that the comprehensive tariff system, including the TARDOC catalog of individual service tariffs and outpatient flat rates, is now available for review by interested parties. As emphasized by the OAAT AG, the new system has not been approved yet. After the partial approval by the Swiss Federal Council in June 2024, the implementation of the new system was postponed until January 2026.

The French National Authority for Health (HAS) released new recommendations about add-on reimbursement of medical devices from the meetings of the National Commission for Evaluation of Medical Devices and Health Technologies (CNEDiMTS) in August 2024. Five recommendations were published concerning the registration of medical devices or modification of registration conditions/extension of indications for the medical devices in the List of Reimbursable Products and Services (LPPR). Opinions concern cardiovascular, peripheral vascular, neuromodulation, orthopedic, and spine devices.

On August 2, 2024, the HAS published positive opinions on the inclusion of targeted high-throughput sequencing of gene panels in the medical management of lung cancer, gastrointestinal stromal tumors, and chronic lymphocytic leukemia in the NABM Nomenclature. This is a consequence of the efforts to disburden the innovation funding budget and clean the List of IVD tests outside the Nomenclature (Liste des actes hors nomenclatures, AHN, i.e., the merged 2023 RIHN List and the Supplementary List funded outside Statutory Health Insurance via the research and innovation budget).

On July 15, 2024, the Austrian Institute for HTA (AIHTA) published three decision support documents that provide recommendations regarding the inclusion of new medical interventions in the catalog of individual medical services (MEL) for reimbursement, as well as two updates to previous decision support documents. The decisions relate to cardiovascular, peripheral vascular, interventional radiology, neuromodulation, and endocrine technology groups.

On June 19, 2024, the Swiss Federal Council granted partial approval to the new outpatient reimbursement system, consisting of the TARDOC catalog of individual service tariffs and the flat-rate system, which were developed independently. Adjustments were requested to ensure better coordination and adherence to cost neutrality. The full implementation of the new system is now postponed until 2026.

The application window for changes in the Swiss classification of surgical procedures (CHOP) will open on June 3, 2024. The eligible applicants can submit applications until September 15, 2024.

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 May 07, 2024, the Dutch Healthcare Institute (ZIN) published the updated list of medical procedures reimbursed under basic health insurance with restrictions or limitations. The additional indications for autologous fat transplantation after a total breast removal were newly introduced to the list.

On April 18, 2024, the French National Authority for Health (HAS) announced the submission of requests for registration in the 2025 HAS Good Practice Recommendations Work program – for professional organizations and in the 2025 HAS Work program – for patient associations.

On May 1, 2024, the Swiss Federal Council adopted a message to amend the Federal Health Insurance Act (KVG) following a parliamentary mandate, which requires a change in how tariffs for laboratory analyses are determined. Instead of being set by the Federal Department of Home Affairs (FDHA), the tariffs of tests in the List of Analyses will be determined through negotiations between collective bargaining partners, streamlining the inclusion of innovative analyses and slowing down the increase in healthcare costs.