The role of payment mechanisms and financial incentives in healthcare innovation: a systematic review

Context: Innovation is considered essential for the quality and sustainability of healthcare systems. However, the path from innovative idea to adopted reality is complex and filled with many factors that influence the innovation process in different ways. One of those factors are existing payment mechanisms and the incentives embedded therein. These mechanisms undoubtedly influence the development and implementation of innovations in healthcare, but how and the extent to which this is the case remains largely unknown. We sought to provide a comprehensive overview of the role that payment mechanisms play in healthcare innovation and the financial issues that innovators encounter in different phases of the innovation process.

Methods: We combined systematic data search and extraction with textual narrative synthesis in order to realize a comprehensive, in-depth analysis of the literature. We searched Embase, Medline, Cochrane Central Register of Controlled Trials, Web of Science Core Collection and Google Scholar (200 top-ranked) for peer-reviewed publications. The heterogenous literature was grouped and analyzed in categories of innovation type (product or process), phase in the innovation process (development, translation, implementation), and payment type (funding or reimbursement). Findings were synthesized narratively and visualized using financial Fugle models.

Findings: Of the 7,639 articles identified, 135 were included in the review. Among the wide variety of results, three key findings stand out: 1) shortcomings in national reimbursement systems result in locally fragmented implementation of innovations; 2) a lack of evidence on costs and benefits in financial decision-making might harm the development and implementation of potentially value-enhancing innovations; and 3) the level of disruptiveness of an innovation determines the severity of financial barriers. We further found that non-financial aspects such as innovator characteristics (e.g., networking skills) and institutional support (e.g., legal advice) are essential in overcoming the financial barriers.

Conclusions: Despite the availability of many different funding and reimbursement sources throughout the innovation process for both innovative products and processes, strong financial disincentives were identified for disruptive, value-enhancing innovations. Obstructing such innovations from national implementation could endanger the sustainable development of healthcare systems. Based on our results, we formulate seven propositions for policymakers and payers to better facilitate value-enhancing innovation in healthcare.

Zoom link: https://eur-nl.zoom.us/j/96481653074?pwd=UkN3VTRaWjBUWFZRNGRGdGsyenBzUT09&from=addon

Meeting ID: 964 8165 3074