Reimbursement

On January 15, 2024, the National Institute for Health and Disability Insurance (INAMI-RIZIV) released an updated DRG system for 2024. No significant changes were made aand no new APR-DRGs were added; thus. The reimbursement tariffs were increased by about 5%.

In December 2023, the Swiss parliament adopted the uniform financing of outpatient and inpatient services (EFAS). Currently, inpatient benefits are financed jointly by health insurers and the cantons, whereas outpatient services are entirely funded by the insured. The EFAS will come into force in January 2028 and bring a uniform way of financing inpatient and outpatient services; the healthcare system is expected to be integrated into this system four years later.

In December 2023, the reimbursement scheme for outpatient pathology services was updated for 2024. This scheme has been gradually introduced in Norway since 2022. It comprises fee-for-service reimbursement by the Norwegian Health Economics Administration (Helfo) using Pathology Activity Codes (APAT). Fourteen new reimbursement codes were introduced.

Between early September 2023 and mid-January 2024, four more health apps were introduced in the Directory of digital health applications (DiGAs) at the Federal Office for Drugs and Medical Devices (BfArM) and thus became reimbursable. These apps can be prescribed by physicians and psychotherapists and will be reimbursed by health insurers. In total, 53 health apps are currently available in the DiGA Directory, and six health apps were delisted from the Directory.

On December 21, 2023, the Dutch Healthcare Authority (NZa) issued a draft release of the DRG package for 2025, including new procedure codes, new diagnosis codes, and several new DRGs. These changes concern gynecology, cardiology, gene therapy and other technology groups.

On January 3, 2024, the entity managing the DRG system in Switzerland, SwissDRG, announced that they will be accepting applications for changes in the DRG system from June 3, 2024, until July 15, 2024. The results of the DRG applications made in 2024 will be reflected in the 2026 version of SwissDRG.

NHS England defined a deadline for applications to the High Cost Device List (HCDL) changes to be implemented in the 2025/26 NHS Payment Scheme. The completed application form should be submitted via email by May 31, 2024.

On January 01, 2024, the Dutch Healthcare Institute (ZIN) published the updated list of medical procedures reimbursed under basic health insurance with restrictions or limitations. The procedures that were newly introduced to the list concern pulmonary, gynecology and ENT procedures, as well as genetic testing.

In December 2023, NHS England launched a consultation regarding proposed changes in the 2023/25 NHS Payment Scheme for the 2024/25 financial year. The key changes concerned the High Cost Device List, top-up payments for specialized services, and payment for radiotherapy. The deadline for submitting comments is January 26, 2024.

In December 2023, the Norwegian Directorate of Health published a final version of the DRG system (Innsatsstyrt finansiering, ISF) for 2024. In general, no significant changes were introduced. No new DRGs will be added. One new Special Service Group (STG) for light treatment and five new Service Progress Groups (TFGs) concerning maternity care pathways and rehabilitation will be introduced.

On December 20, 2023, the National Association of Statutory Health Insurance Funds (GKV-Spitzenverband) announced that from January 1, 2024, the catalog for ambulatory operations in hospitals (AOP catalog) will be significantly expanded – 171 interventional procedures will be included in the catalog.

In December 2023, the Dutch Healthcare Institute (ZIN) published two coverage positions on high-intensity focused ultrasound (HIFU) in patients with essential tremor with positive recommendation for coverage under basic insurance package, and on radiotherapy with magnetic resonance linear accelerator, which was not recommended for coverage under the basic insurance package.