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Pricing and Reimbursement Strategies for Diagnostics: Overcoming Reimbursement Issues and Navigating the Regulatory Environment
Business Insights, June 2010, Pages: 125
The reimbursement for diagnostics is the key requirement for both the diagnostic providers and the payers because while 5-7% of the hospital cost is incurred on diagnostics, they are used for around 70% of the healthcare decisions. Developing an optimum price especially with respect to emerging diagnostic technologies such as molecular diagnostics has been very challenging as evidence-based pricing does not suffice for such technologies. This complicates the scenario for early movers in diagnostics. However, there has been an on-going issue even with respect to existing technologies, as the companies have an immense need to re-consider their pricing strategies to deal with cost and demand versus reimbursement issues. Hence, it is very crucial to identify novel pricing strategies to maintain a fair plane among all the stakeholders.
Key features of this report
- Regulatory structure for U.S. and Europe
- Existing pricing strategies for healthcare diagnostic equipments
- Novel pricing strategies for healthcare diagnostic equipments
- Strategic recommendations for existing and first mover healthcare diagnostic equipments
- Indicative prices and reimbursement amounts for healthcare diagnostic equipments
Scope of this report
- Understand the existing structure for reimbursements for healthcare diagnostic equipments developed markets
- Understand the existing pricing for healthcare diagnostic equipments for developed markets
- Understand the role of various factors impacting price of the healthcare diagnostic equipments
- Understand the evolution of pricing strategies in recent times within healthcare diagnostic equipments
- Helps in determining the complete understanding of changing times within pricing with respect to reimbursements
Key Market Issues
- The healthcare diagnostic industry is currently facing the issue of lack of reimbursements for various procedures which are extremely critical to patient diagnosis
- This lack of reimbursements has started to affect the market negatively and the major markets in developed economies are seeing a negative to flat growth rate
- Various end users are using this opportunity to push the prices of the healthcare diagnostic products further down, which can lead to decrease in the size of the industry
- Various countries in Europe have their own reimbursement structure and policies with respect to various procedures. This is creating lot of bureacratic and pricing hurdles for the Original Equipment Manufacturers (OEMs) of these products.
- Various governments in Europe are changing their reimbursement policies with respect to new products launched within the healthcare diagnostic industry.
Key findings from this report
- A procedure might have a higher chance of getting insurance coverage, if it reduces the overall healthcare cost.
- The recent reduction made by the CMS in the reimbursement amount for non-facility units is expected to impact the diagnostic devices market especially in the form of lack of innovation.
- The reimbursement structure is restraining the growth of innovative technologies such as molecular diagnostics.
- An OEM’s pricing is fundamentally based on its desired Return-on-Investment and the overall cost of manufacturing its equipment.
- Fair Value Pricing and Risk Sharing Pricing are the new methods of pricing within healthcare diagnostics
Key questions answered
- What is the existing reimbursement structure within the major markets in healthcare diagnostics?
- What are existing pricing strategies employed by healthcare diagnostic Original Equipment Manufacturers (OEMs)?
- What is the impact of current reimbursement policies over the pricing of healthcare diagnostic equipment pricing?
- How do the OEMs of healthcare diagnostic equipments price their products considering reimbursement policies across the world?
- What are the possible drawbacks of recent changes in reimbursement policies across the globe?
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