I would like to ask about the reimbursement policies in your countries for the interventional procedures like peripheral arterial, venous, EVAR, etc. What are the conditions/procedures required by the social security and/or private security companies and approximate amounts of payment?
Do they account for lower/cheaper numbers compared to surgical counterparts?
Is your question about payment to physician, hospital, or both? Also, what do you mean by "account for lower/cheaper numbers comapred to surgical counterparts"? Cheaper costs to hospital to perform the procedure (that is, less resource intensive for the hospital to provide this procedure)?
I work in this field here in Brazil and we have 2 distinct universes in our country: an universal public health system (used by all - 200 million people) and a strong private supplementary health system (used by 50 million people). Both systems are highly regulated and each one has its own rules for interventional procedures coverage. I realized you also came from an emerging country and I'll be glad to help. If you're interested, please contact me with more details.
I mean both.. In Turkey, reimbursement is planned for the interventions as a package in most cases in cardiovascular surgery. For example, there is a standard price that the social security pays (for a coronary procedure starting from 2000-2500$ to 5000$ or a Fem-pop case is around 500-1000$). The interventional procedures (like endovascular-EVAR, peripheral arterial etc) are debated nowadays. The prices of the equipment is far more expensive than the conventional surgical operations. When I look at the prices in US, these procedures seem significantly cheaper than surgery.
We have the same problem here, because public health system pays providers the same way as you described in Turkey. And here we also have high prices for endovascular material as well. Part of this problem is explained because of our huge taxes, but unfortunatelly it doesn't explain all. These devices prices here are 4-10 times greater than in US, or even more... Some providers got succesfull negociations with our government, improving these prices for them (but not for the entire system). I think you should try the same, maybe doing a cost analysis to show the prices differences compared to standard procedure and highlighting the benefits of endovascular procedures for your patients (if possible). Good luck!
These procedures are reimbursed according to the DRG (Diagnosis Related Groups) system in Austria (see http://www.bmg.gv.at/home/EN/Topics/The_Austrian_DRG_system_brochure_)
The money comes from a fund which is financed by social insurance and government.
In Germany the mechanisms for reimbursement are similar to Austria. Procedures are reimbursed according to DRGs. The money comes from social health insurance funds. Generally, DRGs are updated annually using a grouping algorithm based on data concerning diagnoses, procedures, patient characteristics, cause of hospital discharge, and length of stay. Each DRG is assigned a fixed cost weight, which is the same throughout Germany.
I think Patricia what you meant in the last sentence is actually a cost-effectiveness analysis: justyfing higher cost for the new procedure with enhanced clinical effectiveness.
In the U.S., the actual cost for a hospital to provide interventional procedures is less than open surgical procedure (vascular surgery) because the price of the endovascular ("minimally invasive") interventional equipment is relatively low and fewer hospital inpatient days or Length-of-Stay (LOS) is much shorter than open surgery. Therefore the health insurance companies and the government socialized insurance programs (Medicare for elderly and Medicaid for low income) pay the hospitals less for the interventional procedures. Generally these procedures are better for the patients (less morbidity and mortality and equally effective outcomes) and are considered more "cost-effective" than the open surgical procedures. Some patients are not candidates for interventional procedures and must undergo open surgical procedures. Hospitals get paid more for these procedures (based on resource cost of providing open surgical operations and longer LOS) and the hospital makes a better profit margin also. The payment to physician/surgeon is not much different for interventional vs open surgical procedures because the amount of time the physician/surgeon spends in the evaluation/procedure/postop care is about the same.
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