Medical Delta's Journey from Prototype to Payment

Medical Delta aims to realize sustainable care with technological solutions. For an innovation to be sustainable, it is important to understand its full impact on society. This includes clinical, financial, organizational, and ethical factors, among others.

Moreover, innovations need to be safe, and their value should be proven. In 2014, the Dutch television program Radar was able to receive CE-certification for a pelvic floor mat using a tangerine bag. This semi-serious prank showed the need for stricter regulation of technologies and increased expectations regarding their proven value to society. In the Medical Delta program From Prototype to Payment, the societal perspective on innovation is positioned in parallel to the other scientific programs. The From Prototype to Payment program focuses on four pillars: 1) financial aspects, 2) health technology assessment, 3) governance and 4) organizational aspects. Each of these four pillars is elaborated on below in more detail.

From Prototype to Payment

The Medical Delta program ‘From Prototype to Payment’ considers these types of questions:

Financial aspects

What will be the financing model of a new technology? A device that will be used once inside the hospital will have a completely different business model than a device that will be used multiple times outside the hospital. Another question is who should buy the device? The hospital, insurance companies or the patients themselves? In this PhD project we aim to understand the important financial aspects influencing innovation from its development to its implementation in practice. By adopting the perspective from the innovators, we dive into their world and emphasize the financial struggles they encounter during the innovation process.

Health technology assessment

The development of new technologies should be guided by the assessment of its potential risks, costs, benefits and impact. A Health Technology Assessment (HTA) is a policy framework used to decide on market access and the reimbursement of new technologies. HTA provides the methods to assess efficacy, organizational consequences, financial questions and cost-effectiveness. Cost-effectiveness of a new technology is an essential part of the assessment. HTA looks at how much a certain technology costs and what added value it offers. It compares new technologies to technologies that are currently used. For instance, in the case of MRI scanners, it tries to understand whether it's worth investing in new ones that, despite being more advanced than current ones, cost a lot more. By adopting a societal perspective in a such HTA framework, we include not only medical costs, but also costs outside of the healthcare system (e.g., costs for family, productivity costs).

Governance

What are the implications of the development of medical technologies for the governance of health care? How are (innovative) medical technologies governed at a national and an international level? With the expectation of new regulations, the development of novel methods for value assessment, and the introduction of various new players, responsibilities are changing. Conventional means of regulating these new technologies may not be feasible, nor sufficient to guarantee the quality, accessibility and affordability of medical technologies. In this PhD project, the governance of medical technology will be studied with a focus on the role of HTA bodies.

Organizational aspects

Organizational and professional consequences relate to the effects of implementing a new technology. Once brought into practice, technologies often generate unexpected, and even unintended, consequences. We thus need to ask, which new tasks will the technology create? Do we need to create new professional roles to take care of them? Will physicians delegate tasks to nurses? Will professionals trust new types of information provided, for instance, by data-driven technologies?

The PhD projects that are part of the From Prototype to Payment program can be combined to provide a full picture of the societal questions that need to be asked before, during and after technological innovation. Together, they can be integrated to inform decision-making at multiple levels of the health care system, from national reimbursement assessment to organizational decision making on how to optimize service delivery.

Collaboration

It is important to involve many stakeholders in this Medical Delta program, in order to provide a truly parallel answer to the other scientific programs. For instance, collaboration with the National Healthcare Institute (Zorginstituut Nederland) is essential for the governance aspects. Next to the Healthcare Institute, this program collaborates closely with innovators, healthcare professionals, healthcare insurers, patients and industry to understand the full societal impact of innovative technologies.