Reimbursement and HTA Submissions

In DRG-based countries, the reimbursement process includes the creation of a specific procedure code and a subsequent application for the creation of a new DRG or re-grouping of the procedure in scope to another existing DRG. The creation of an appropriate DRG tariff helps to secure sufficient reimbursement and funding for hospitals and supports the adoption of novel medical technologies.

Reimbursement applications are made by clinical societies or physicians (hospital administrators). However, the development of the application takes time and often requires specialized expertise and coordination with data collection between several clinics. Physicians and key opinion leaders often do not have time to develop a proper application.

Health technology assessment or coverage (e.g. in Hungary) applications typically require a comprehensive systematic review of clinical effectiveness and safety, health economic evaluation (cost-effectiveness, budget impact analysis) adapted to the specifics of the country, specific search for country-specific epidemiological and regulatory data. 

MTRC provides support with the development of reimbursement and HTA applications in the Nordic region, England, and other selected geographies. Reimbursement submissions in other geographies are performed by our local partners.