Uptake and diffusion of medical technology innovation in Europe: what role for funding and procurement policies?

The producers of medical technology constantly strive to innovate and to improve their products for the benefit of patients. With each new generation of devices enabling less invasive techniques, better clinical outcomes and reduced recovery times, patients are direct beneficiaries of this commitment to innovation. Innovation and patient access to technology are inseparably linked with each national health system's respective coverage, procurement and reimbursement policies. If a particular innovation is not included in the basket of services covered by public resources, there may be a time lag before it enters the system and reaches patients. If the procurement criteria focus primarily on price, it is likely that the quality and innovativeness will be penalised. Finally, if the use of an innovative technology leads to higher costs for the health-care provider, it has to bear the cost until the reimbursement mechanism is updated to include the new technology. Today there are substantial regional differences relative to the financial incentives for introducing new technology and in some cases, it can take years before the new technologies are recognised, which can inhibit the roll-out of innovation within the health system. In addition to utilising different policy choices for funding and procurement, the decision-making criteria used to inform policies vary greatly in European countries. Increasingly, health-care policymakers want scientific, technological and economic evidence before classifying a new technology as reimbursable. Although it is important to ensure that new medical devices are superior to conventional treatments, due to short-sightedness in certain assessment mechanisms and limited availability of clinical trial information, the reliability of estimates of the efficacy and cost-effectiveness can be questioned. As health technology assessment procedures are centralised, it becomes ever more important that coverage decisions regarding new medical devices are made on sound, robust criteria and that they include the full economic benefits – to the patient, to the health-care system and to society – of innovative new technology. As pressure on health-care funding mounts, reimbursement policy, in particular, is being refocused to target the contrasting objectives of healthcare expenditure containment and support of innovation. Looking forward, the successful balancing of technological adoption and affordability will require a judicious use of policy levers and will probably be accompanied by more regulatory action