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Bepaling van het remgeld in functie van de maatschappelijke waarde van een verstrekking of product / Irina Cleemput / Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre (2012)  

Bepaling van het remgeld in functie van de maatschappelijke waarde van een verstrekking of product [printed text] / Irina Cleemput , Author ; Carl Devos , Author ; Stephan Devriese , Author ; Maria-Isabel Farfan-Portet, Author ; Carine Van de Voorde, Author . - Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre, 2012 . - V, 122 p. : Ill, ; A4. - (KCE Reports A. Health Services Research (HSR); 186A) . ISSN : D/2012/10.273/62 : € 0,00 Languages : English (eng) Dutch (nla) Descriptors: Classification W 74 Medical economics. Health care costs (General) Indexation 2010-19 ; Cost-sharing ; Deductibles and Coinsurance ; Health Care Reform ; Health Services Accessibility ; Insurance, Health ; R186 Abstract: Remgelden bestaan in België al bijna 50 jaar, en ze zijn sterk gedifferentieerd en complex. Op vraag van het RIZIV bestudeerde het Federaal Kenniscentrum voor de Gezondheidszorg (KCE) een aantal belangrijke pijnpunten. Het systeem wordt best vereenvoudigd. Zo kunnen verschillen in remgelden op basis van het aantal patiënten dat de huisarts per huisbezoek ziet of de woonplaats van de patiënt worden afgeschaft. Hoe hoger de maatschappelijke meerwaarde van een medische interventie, hoe lager het remgeld zou moeten zijn. Dit zou bijdragen tot een meer kwaliteitsvolle en doeltreffende gezondheidszorg. Het KCE pleit er dus voor om het remgeld niet langer gewoon te berekenen als een percentage van het ereloon van de arts of de kostprijs van een geneesmiddel. Belangrijk is dat bij dit alles een globale visie wordt uitgewerkt, waarbij wordt nagedacht over de doelstellingen van de remgelden. Contents note: SYNTHESE 9 -- 1. ACHTERGROND 9 -- 2. DEFINITIE EN DOELSTELLINGEN VAN VALUE-BASED INSURANCE 10 -- 3. VALUE-BASED INSURANCE DESIGNS 11 -- 4. EFFECTEN VAN VALUE-BASED INSURANCE 12 -- 5. ISSUES IN VALUE-BASED INSURANCE 13 -- 5.1. VOORWAARDEN EN HINDERPALEN OM VBI TE IMPLEMENTEREN 13 -- 5.2. “VALUE-BASED INSURANCE” VERSUS “VALUE-BASED PRICING” 13 -- 5.3. STEUNT DE PUBLIEKE OPINIE VBI?... 15 -- 5.4. VALUE-BASED INSURANCE EN REMGELD ALS VAST BEDRAG OF PERCENTAGE 15 -- 6. ILLUSTRATIE VAN EEN MOGELIJKE TOEPASSING VAN VALUE-BASED INSURANCE VOOR GENEESMIDDELEN EN DE BUDGETTAIRE IMPACT ERVAN 15 -- 7. BESLUIT 17 -- SCIENTIFIC REPORT 19 -- 1. INTRODUCTION 19 -- 1.1. GENERAL BACKGROUND 19 -- 1.2. SCOPE AND RESEARCH QUESTIONS 20 -- 1.3. METHODS 20 -- 1.4. CONTENT OF THE REPORT 20 -- 2. THE ROLE OF DEMAND-SIDE COST SHARING IN A SOCIAL INSURANCE SYSTEM 21 -- 2.1. DIMENSIONS OF HEALTH INSURANCE COVERAGE 21 -- 2.1.1. Breadth of the coverage 21 -- 2.1.2. Depth of the coverage 21 -- 2.1.3. Height of the coverage 21 -- 2.2. A BRIEF INTRODUCTION ON OPTIMAL COST SHARING 22 -- 2.2.1. Cost shifting 22 -- 2.2.2. Fighting moral hazard... 22 -- 2.2.3. Steering behaviour of imperfectly informed patients 23 -- 2.3. HEALTH INSURANCE COVERAGE AND VALUE-BASED INSURANCE 23 -- 2.4. DIFFERENTIATED COST SHARING IN BELGIUM 23 -- 2.4.1. Disease management programme for type 2 diabetes 23 -- 2.4.2. Pharmaceuticals 24 -- 2.4.3. Healthcare services 27 -- 3. THE CONCEPT OF VALUE-BASED INSURANCE 27 -- 3.1. THE BASIC PRINCIPLE OF VALUE-BASED INSURANCE 27 -- 3.2. DEFINITION OF VALUE 28 -- 3.2.1. Value in value-based insurance 28 -- 3.2.2. Value-based pricing 29 -- 3.2.3. Value in value-based pricing 30 -- 3.2.4. Issues with value-based pricing in practice 30 -- 3.2.5. Value-based insurance when value-based pricing fails 31 -- 4. TYPES OF VALUE-BASED INSURANCE DESIGNS 35 -- 4.1. DESIGNS IN GENERAL 35 -- 4.2. VALUE-BASED INSURANCE DESIGNS IN FUNCTION OF THE TYPE OF SERVICE 39 -- 4.2.1. One size does not fit all 39 -- 4.2.2. Belgian examples 41 -- 5. ISSUES IN VALUE-BASED INSURANCE 43 -- 5.1. VALUE-BASED INSURANCE AND SOCIAL PROTECTION 43 -- 5.2. VALUE-BASED INSURANCE AND COINSURANCE VERSUS CO-PAYMENT 43 -- 5.3. CONDITIONS FOR IMPLEMENTING VALUE-BASED INSURANCE 45 -- 5.3.1. Evidence on the value of healthcare services 45 -- 5.3.2. Efficient targeting 46 -- 5.3.3. Data requirements 47 -- 5.3.4. Auditing 47 -- 5.3.5. Patient and physician information 47 -- 5.3.6. Integrated approach 48 -- 5.4. PUBLIC ACCEPTANCE AND SUPPORT FOR VALUE-BASED INSURANCE 48 -- 6. IMPACT OF VALUE-BASED INSURANCE 49 -- 6.1. EXPECTED BENEFITS OF VALUE-BASED INSURANCE 49 -- 6.1.1. Impact on adherence... 49 -- 6.1.2. Impact on healthcare expenditures 50 -- 6.1.3. Impact on access to healthcare 50 -- 6.2. REAL-LIFE EXPERIENCES IN THE US 51 -- 6.2.1. Value-based co-payment tiers for pharmaceuticals 51 -- 6.2.2. Costs and outcomes of value-based insurance designs 52 -- 6.3. EVALUATION OF VALUE-BASED INSURANCE DESIGNS IN BELGIUM 57 -- 7. ILLUSTRATION OF A POSSIBLE APPLICATION OF VALUE-BASED INSURANCE PRINCIPLES TO ANTIDEPRESSANTS... 58 -- 7.1. OBJECTIVE AND SCOPE 58 -- 7.2. INDICATIONS FOR ANTIDEPRESSANTS 59 -- 7.2.1. Severe depression 59 -- 7.2.2. Label extensions 59 -- 7.2.3. Off-label use 59 -- 7.3. USE OF ANTIDEPRESSANTS 60 -- 7.3.1. Volume increase 60 -- 7.3.2. Antidepressant treatment duration and non-persistence 60 -- 7.4. SIMULATION OF A VALUE-BASED INSURANCE DESIGN FOR ANTIDEPRESSANTS 61 -- 7.4.1. Microsimulation as a tool for the analysis of policy measures 61 -- 7.4.2. Description of the data 61 -- 7.4.3. Analysis sample 62 -- 7.4.4. Defining a treatment episode 64 -- 7.4.5. Social protection measures 65 -- 7.4.6. Simulation scenarios 65 -- 7.5. RESULTS OF THE BASELINE SITUATION 67 -- 7.6. RESULTS OF THE SIMULATED SCENARIOS 71 -- 7.7. DISCUSSION 76 -- 7.7.1. Appropriateness and feasibility of a higher patient cost sharing for a first prescription 76 -- 7.7.2. Shared responsibilities 77 -- 8. CONCLUSION 77 -- APPENDICES 79 -- REFERENCES 119 Link for e-copy: https://doi.org/10.57598/R186A Format of e-copy: PDF (1,3 Mb) Record link: https://kce.docressources.info/index.php?lvl=notice_display&id=3065

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Bepaling van het remgeld in functie van de maatschappelijke waarde van een verstrekking of product / Irina Cleemput / Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre (2012)  

Bepaling van het remgeld in functie van de maatschappelijke waarde van een verstrekking of product : Synthese [printed text] / Irina Cleemput , Author ; Carl Devos , Author ; Stephan Devriese , Author ; Maria-Isabel Farfan-Portet, Author ; Carine Van de Voorde, Author . - Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre, 2012 . - 11 p. : Ill, ; A4. - (KCE Reports A. Health Services Research (HSR); 186AS) . ISSN : D/2012/10.273/64 : € 0,00 Languages : Dutch (nla) Descriptors: Classification W 74 Medical economics. Health care costs (General) Indexation 2010-19 ; Cost-sharing ; Deductibles and Coinsurance ; Health Care Reform ; Health Services Accessibility ; Insurance, Health ; R186 Abstract: Remgelden bestaan in België al bijna 50 jaar, en ze zijn sterk gedifferentieerd en complex. Op vraag van het RIZIV bestudeerde het Federaal Kenniscentrum voor de Gezondheidszorg (KCE) een aantal belangrijke pijnpunten. Het systeem wordt best vereenvoudigd. Zo kunnen verschillen in remgelden op basis van het aantal patiënten dat de huisarts per huisbezoek ziet of de woonplaats van de patiënt worden afgeschaft. Hoe hoger de maatschappelijke meerwaarde van een medische interventie, hoe lager het remgeld zou moeten zijn. Dit zou bijdragen tot een meer kwaliteitsvolle en doeltreffende gezondheidszorg. Het KCE pleit er dus voor om het remgeld niet langer gewoon te berekenen als een percentage van het ereloon van de arts of de kostprijs van een geneesmiddel. Belangrijk is dat bij dit alles een globale visie wordt uitgewerkt, waarbij wordt nagedacht over de doelstellingen van de remgelden. Link for e-copy: https://doi.org/10.57598/R186AS Format of e-copy: PDF (292 Kb) Record link: https://kce.docressources.info/index.php?lvl=notice_display&id=3066

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Cost sharing and protection mechanisms in health / Maria-Isabel Farfan-Portet / Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre (2019)  

Cost sharing and protection mechanisms in health : Examples of Hypothetical simulations: Results [printed text] / Maria-Isabel Farfan-Portet, Author ; Nicolas Bouckaert, Author ; Stephan Devriese , Author ; Carl Devos , Author ; Carine Van de Voorde, Author . - Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre, 2019 . - 98 p. : ill., ; A4. - (KCE Reports. Health Services Research (HSR); 309C) . ISSN : D/2019/10.273/16 : € 0,00 Languages : English (eng) Descriptors: Classification W 74 Medical economics. Health care costs (General) Indexation 2010-19 ; Cost-sharing ; Financing, Personal ; Health Expenditures ; Health Services Accessibility ; Insurance Coverage ; R309 Contents note: SCIENTIFIC REPORT .7 -- 1 INTRODUCTION 7 -- 1.1 GENERAL BACKGROUND .7 -- 1.2 SCOPE OF THE STUDY 8 -- 1.3 RESEARCH METHODS AND OVERVIEW OF THE REPORT .9 -- 2 CHANGES IN SOCIAL PROTECTION MECHANISMS BETWEEN 2012 AND 2016 10 -- 2.1 SUMMARY OF POLICY CHANGES .10 -- 2.2 ESTIMATING THE DIFFERENCE BETWEEN OMNIO BENEFICIARIES AND COMPLETE TAKE-UP FOR THE OMNIO STATUS .12 -- 2.2.1 Complete take-up for the OMNIO status 12 -- 2.3 LIMITING THE TRANSFER OF THE ENTITLEMENT TO OMNIO TO MEMBERS OF THE ‘REFERENCE’ HOUSEHOLD 18 -- 2.3.1 Transfer of the entitlement to OMNIO to members of the reference household 18 -- 2.4 SIMPLIFICATION OF THE SYSTEM OF INCREASED REIMBURSEMENT 20 -- 2.4.1 Increased reimbursement in 2014 20 -- 2.4.2 Impact of a systematic control: households losing the right to increased reimbursements 28 -- 2.4.3 Impact of changing the reference household definition 29 -- 2.5 CHILD MAB FOR HANDICAPPED CHILDREN 30 -- 2.6 POLICIES FOR PERSONS WITH A CHRONIC ILLNESS 33 -- 2.6.1 Situation before 2014: impact of the MAB for the chronically ill 33 -- 2.6.2 Situation after 2014: introduction of the status of person with chronic illness 37 -- 2.6.3 Status of a person with a chronic illness 41 -- 3 INTRODUCTION OF NEW CHANGES IN SOCIAL PROTECTION MECHANISMS .45 -- 3.1 SUMMARY OF NEW POLICY MEASURES .45 -- 3.2 RESTRICTING THE MAB FOR THE CHRONICALLY ILL (N_7) TO AVOID OVERLAP WITH THE STATUS OF A PERSON WITH A CHRONIC ILLNESS .48 -- 3.3 ABOLISHING THE RIGHT TO INCREASED REIMBURSEMENT FOR HOUSEHOLDS WITH AN INCOME ABOVE THE THRESHOLD (N_8) .51 -- 3.4 INCLUDING STAYS IN A PSYCHIATRIC HOSPITAL IN THE MAB COUNTER 56 -- 3.5 ESTIMATION OF THE MAB CEILING BASED ON THE NET INCOME OF THE PREVIOUS YEAR .60 -- 3.6 FISCAL REFORMS: SHIFT FROM TAX DEDUCTIONS TO TAX REDUCTIONS 66 -- 3.7 MODIFICATION TO THE MAB SYSTEM: ABOLISHING THE SOCIAL MAB AND INTRODUCING A CEILING OF € 250 FOR LOW-INCOME HOUSEHOLDS .72 -- 3.7.1 Abolishing the social MAB and introducing a ceiling of € 250 for low-income households based on the net taxable income (NTI) of 2009 72 -- 3.7.2 Abolishing the social MAB and introducing a ceiling of € 250 for low-income households based on the net taxable income (NTI) of 2011 78 -- 3.8 INDEXATION ON THE INCOME MAB THRESHOLDS AND CEILINGS 84 -- 3.8.1 Indexation of the MAB ceilings 84 -- 3.8.2 Indexation of the MAB income thresholds 88 -- 3.8.3 Changes in the number of households entitled to the social and income MAB: analysis in -- light of the simulation results 92 -- 3.9 INCOME-RELATED DEDUCTIBLE EXCLUDING GP SERVICES 93 -- REFERENCES .98 Link for e-copy: https://doi.org/10.57598/R309C Format of e-copy: PDF (1,6 Mb) Record link: https://kce.docressources.info/index.php?lvl=notice_display&id=4522

Cost sharing and protection mechanisms in health / Maria-Isabel Farfan-Portet / Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre (2019)  

Cost sharing and protection mechanisms in health : Technical manual [printed text] / Maria-Isabel Farfan-Portet, Author ; Nicolas Bouckaert, Author ; Stephan Devriese , Author ; Carl Devos , Author ; Carine Van de Voorde, Author . - Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre, 2019 . - 70 p. : ill., ; A4. - (KCE Reports. Health Services Research (HSR); 309S) . ISSN : D/2019/10.213/17 : € 0,00 Languages : English (eng) Descriptors: Classification W 74 Medical economics. Health care costs (General) Indexation 2010-19 ; Cost-sharing ; Financing, Personal ; Health Expenditures ; Health Services Accessibility ; Insurance Coverage ; R309 Abstract: 1. INTRODUCTION 6 -- 2. DESCRIPTION OF THE DATA 7 -- 2.1. IMA DATA 7 -- 2.2. FISCAL DATA 7 -- 2.3. INTERNAL CONSISTENCY OF THE DATA 8 -- 2.3.1. IMA: population data 8 -- 2.3.2. IMA: healthcare expenditure data/Pharmanet 9 -- 2.3.3. Valid observations in the IMA data 10 -- 2.3.4. Fiscal data 11 -- 2.4. FINAL SAMPLE 15 -- 2.5. ADJUSTING THE VALUES OF VARIABLES 15 -- 2.5.1. Inconsistency in the transfer of eligibility to increased reimbursement of healthcare expenses from the beneficiary to the dependents .15 -- 2.5.2. Inconsistency between eligibility to increased reimbursement and the maximum billing system 16 -- 2.6. CREATING DERIVED VARIABLES 16 -- 2.6.1. Demographic, socioeconomic or health status variables 16 -- 2.6.2. Net and gross taxable income 18 -- 2.6.3. Entitlement to increased reimbursement of healthcare expenses .20 -- 2.7. TRANSFERRING CHARACTERISTICS OF INDIVIDUALS TO THE HOUSEHOLD .25 -- 3. WEIGHTING PROCEDURE 28 -- 3.1.1. First step: weights based on the age and gender of the household members 28 -- 3.1.2. Second step: adjusting weights based on the household size 30 -- 3.1.3. Comparison of weighted estimates with real healthcare expenses 32 -- 4. SETTING UP THE BASELINE SITUATION IN 2012 34 -- 4.1. CO-PAYMENTS INCLUDED IN THE MAXIMUM BILLING COUNTER .34 -- 4.2. CEILINGS AND REIMBURSEMENT OF CO-PAYMENTS OF THE DIFFERENT MAXIMUM BILLING SUBSYSTEMS 34 -- 4.2.1. Construction of the MAB ceilings in the different subsystems .34 -- 4.2.2. Construction of MAB reimbursements 39 -- 4.3. MAB REIMBURSEMENTS IN THE BASELINE SITUATION: NUMBER OF HOUSEHOLDS AND AMOUNT 41 -- 5. IMPUTATION OF CHANGES IN SOCIAL PROTECTION MECHANISMS BETWEEN 2012 AND 2016 IN THE DATA 44 -- 5.1. CHILD MAB FOR HANDICAPPED CHILDREN 44 -- 5.2. STATUS OF A PERSON WITH A CHRONIC ILLNESS 44 -- 5.3. INCREASED REIMBURSEMENT OF MEDICAL EXPENSES: HOUSEHOLD DEFINITION APPLICABLE IN 2014 45 -- 5.3.1. Household concept as from 2014 46 -- 5.3.2. Definition of the new household concept in the data 47 Link for e-copy: https://doi.org/10.57598/R309S Format of e-copy: PDF (2,02 Mb) Record link: https://kce.docressources.info/index.php?lvl=notice_display&id=4523

Détermination du ticket modérateur en fonction de la valeur sociétale de la prestation ou du produit / Irina Cleemput / Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre (2012)  

Détermination du ticket modérateur en fonction de la valeur sociétale de la prestation ou du produit [printed text] / Irina Cleemput , Author ; Carl Devos , Author ; Stephan Devriese , Author ; Maria-Isabel Farfan-Portet, Author ; Carine Van de Voorde, Author . - Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre, 2012 . - VI, 122 p. : Ill, ; A4. - (KCE Reports B. Health Services Research (HSR); 186B) . ISSN : D/2012/10.1273/63 : € 0,00 Languages : English (eng) French (fre) Descriptors: Classification W 74 Medical economics. Health care costs (General) Indexation 2010-19 ; Cost-sharing ; Deductibles and Coinsurance ; Health Care Reform ; Health Services Accessibility ; Insurance, Health ; R186 Abstract: Les tickets modérateurs existent en Belgique depuis près de 50 ans, et ils sont fort différenciés et complexes. À la demande de l'INAMI, le Centre Fédéral d'Expertise des Soins de Santé (KCE) a étudié un nombre de points sensibles importants. Le système gagnerait à être simplifié. Ainsi, les différences de tickets modérateurs en fonction du nombre de patients examinés pour les visites à domicile du médecin généraliste ou le lieu de la visite pourraient être supprimées. Plus la plus-value sociétale d'une intervention médicale est élevée, plus le ticket modérateur associé devrait être faible. Ceci devrait contribuer à des soins de santé efficaces et de meilleure qualité. Le KCE recommande donc de ne plus comptabiliser le ticket modérateur comme un pourcentage des honoraires médicaux ou du cout d'un médicament. Il importe d'élaborer une vision globale, dans laquelle les objectifs des tickets modérateurs seraient pris en compte. Contents note: SYNTHÈSE 9 -- 1. CONTEXTE 9 -- 2. DÉFINITION ET OBJECTIFS DE LA VALUE-BASED INSURANCE 10 -- 3. FORMES DE VALUE-BASED INSURANCE 11 -- 4. IMPACT DE LA VALUE-BASED INSURANCE 12 -- 5. PROBLÉMATIQUES DE LA VALUE-BASED INSURANCE 13 -- 5.1. CONDITIONS ET OBSTACLES À L’IMPLÉMENTATION D’UNE VBI 13 -- 5.2. « VALUE-BASED INSURANCE » VERSUS « VALUE-BASED PRICING » 14 -- 5.3. L’OPINION PUBLIQUE EST-ELLE FAVORABLE À UNE VBI ? 15 -- 5.4. VALUE-BASED INSURANCE ET TICKET MODÉRATEUR SOUS LA FORME D’UN MONTANT FIXE OU D’UN POURCENTAGE 15 -- 6. ILLUSTRATION D’UNE POSSIBLE APPLICATION DES PRINCIPES DE LA VALUE-BASED INSURANCE AUX MÉDICAMENTS ET IMPACT BUDGÉTAIRE 16 -- 7. CONCLUSION 18 -- SCIENTIFIC REPORT 19 -- 1. INTRODUCTION 19 -- 1.1. GENERAL BACKGROUND 19 -- 1.2. SCOPE AND RESEARCH QUESTIONS 20 -- 1.3. METHODS 20 -- 1.4. CONTENT OF THE REPORT 20 -- 2. THE ROLE OF DEMAND-SIDE COST SHARING IN A SOCIAL INSURANCE SYSTEM 21 -- 2.1. DIMENSIONS OF HEALTH INSURANCE COVERAGE 21 -- 2.1.1. Breadth of the coverage 21 -- 2.1.2. Depth of the coverage 21 -- 2.1.3. Height of the coverage 21 -- 2.2. A BRIEF INTRODUCTION ON OPTIMAL COST SHARING 22 -- 2.2.1. Cost shifting 22 -- 2.2.2. Fighting moral hazard... 22 -- 2.2.3. Steering behaviour of imperfectly informed patients 23 -- 2.3. HEALTH INSURANCE COVERAGE AND VALUE-BASED INSURANCE 23 -- 2.4. DIFFERENTIATED COST SHARING IN BELGIUM 23 -- 2.4.1. Disease management programme for type 2 diabetes 23 -- 2.4.2. Pharmaceuticals 24 -- 2.4.3. Healthcare services 27 -- 3. THE CONCEPT OF VALUE-BASED INSURANCE 27 -- 3.1. THE BASIC PRINCIPLE OF VALUE-BASED INSURANCE 27 -- 3.2. DEFINITION OF VALUE 28 -- 3.2.1. Value in value-based insurance 28 -- 3.2.2. Value-based pricing 29 -- 3.2.3. Value in value-based pricing 30 -- 3.2.4. Issues with value-based pricing in practice 30 -- 3.2.5. Value-based insurance when value-based pricing fails 31 -- 4. TYPES OF VALUE-BASED INSURANCE DESIGNS 35 -- 4.1. DESIGNS IN GENERAL 35 -- 4.2. VALUE-BASED INSURANCE DESIGNS IN FUNCTION OF THE TYPE OF SERVICE 39 -- 4.2.1. One size does not fit all 39 -- 4.2.2. Belgian examples 41 -- 5. ISSUES IN VALUE-BASED INSURANCE 43 -- 5.1. VALUE-BASED INSURANCE AND SOCIAL PROTECTION 43 -- 5.2. VALUE-BASED INSURANCE AND COINSURANCE VERSUS CO-PAYMENT 43 -- 5.3. CONDITIONS FOR IMPLEMENTING VALUE-BASED INSURANCE 45 -- 5.3.1. Evidence on the value of healthcare services 45 -- 5.3.2. Efficient targeting 46 -- 5.3.3. Data requirements 47 -- 5.3.4. Auditing 47 -- 5.3.5. Patient and physician information 47 -- 5.3.6. Integrated approach 48 -- 5.4. PUBLIC ACCEPTANCE AND SUPPORT FOR VALUE-BASED INSURANCE 48 -- 6. IMPACT OF VALUE-BASED INSURANCE 49 -- 6.1. EXPECTED BENEFITS OF VALUE-BASED INSURANCE 49 -- 6.1.1. Impact on adherence... 49 -- 6.1.2. Impact on healthcare expenditures 50 -- 6.1.3. Impact on access to healthcare 50 -- 6.2. REAL-LIFE EXPERIENCES IN THE US 51 -- 6.2.1. Value-based co-payment tiers for pharmaceuticals 51 -- 6.2.2. Costs and outcomes of value-based insurance designs 52 -- 6.3. EVALUATION OF VALUE-BASED INSURANCE DESIGNS IN BELGIUM 57 -- 7. ILLUSTRATION OF A POSSIBLE APPLICATION OF VALUE-BASED INSURANCE PRINCIPLES TO ANTIDEPRESSANTS... 58 -- 7.1. OBJECTIVE AND SCOPE 58 -- 7.2. INDICATIONS FOR ANTIDEPRESSANTS 59 -- 7.2.1. Severe depression 59 -- 7.2.2. Label extensions 59 -- 7.2.3. Off-label use 59 -- 7.3. USE OF ANTIDEPRESSANTS 60 -- 7.3.1. Volume increase 60 -- 7.3.2. Antidepressant treatment duration and non-persistence 60 -- 7.4. SIMULATION OF A VALUE-BASED INSURANCE DESIGN FOR ANTIDEPRESSANTS 61 -- 7.4.1. Microsimulation as a tool for the analysis of policy measures 61 -- 7.4.2. Description of the data 61 -- 7.4.3. Analysis sample 62 -- 7.4.4. Defining a treatment episode 64 -- 7.4.5. Social protection measures 65 -- 7.4.6. Simulation scenarios 65 -- 7.5. RESULTS OF THE BASELINE SITUATION 67 -- 7.6. RESULTS OF THE SIMULATED SCENARIOS 71 -- 7.7. DISCUSSION 76 -- 7.7.1. Appropriateness and feasibility of a higher patient cost sharing for a first prescription 76 -- 7.7.2. Shared responsibilities 77 -- 8. CONCLUSION 77 -- APPENDICES 79 -- REFERENCES 119 -- Link for e-copy: http://doi.org/10.57598/R186B Format of e-copy: PDF (1,3 Mb) Record link: https://kce.docressources.info/index.php?lvl=notice_display&id=3063

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Détermination du ticket modérateur en fonction de la valeur sociétale de la prestation ou du produit / Irina Cleemput / Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre (2012)  

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[Principles and criteria for the level of patient cost sharing: Reflections on value-based insurance] / Irina Cleemput / Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre (2012)  

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Le système du prix de référence et les différences socio-économiques dans l’utilisation des médicaments moins onéreux / France Vrijens / Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre (2010)  

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