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. 2011 Aug 30;3:117–186. doi: 10.2147/CEOR.S14407

Table 1.

Centralized reimbursement system and mandate

Country Centralized reimbursement review/decision-making body (role) Technology scope Decision problem Decision “scope”
 Available decision options
Reimbursement Linkage to pricing Provide Do not provide Provide with restrictions Provide while additional evidence is collected
Austria

  • Association of Austrian Social Security Institutions (decisions)55

  • Pharmaceutical Evaluation Board/Austrian Medicines Evaluation Commission (recommendations)21,56–58
  • Pharmaceuticals
    • – Outpatient55

  • Provide as publicly insured service (reimbursable)55

  • Do not provide as publicly insured service (nonreimbursable)55

 Yes56,59 Yes21,56,59 Yes56 Yes56 Yes56 Not specified
Belgium

  • Minister of Social Affairs (decisions)

  • Commission on reimbursement of medicines/Drug Reimbursement Committee (recommendations)9,60–63
  • Pharmaceuticals
    • – Outpatient
    • – Inpatient21,64

  • Provide as publicly insured service (reimbursable)21

 Yes21 Yes21 Yes21 Yes21 Yes21 Yes21
Czech Republic

  • State Institute for Drug Control (decisions)65–67
  • Pharmaceuticals
    • – Outpatient65

  • Provide as publicly insured service (reimbursable)65

 Yes67 Yes67 Yes65 Yes65 Yes65 Not specified
Denmark

  • Danish Medicines Agency (decisions).68–70 Reimbursement Committee (recommendations)68,70
  • Pharmaceuticals
    • – Outpatient71

  • Provide as publicly insured service38,46,69,71

 Yes68 No68 Yes38,69 Yes38,69 Yes38,69 Not specified
Estonia

  • Ministry of Social Affairs (decisions)72

  • Pharmaceuticals Committee (recommendations)72
  • Pharmaceuticals
    • – Outpatient72

  • Provide as publicly insured service (reimbursable)72

 Yes72 Yes72 Yes72 Yes72 Yes72 No67
Finland

  • Pharmaceuticals Pricing Board (decisions)64,73,74

  • Pharmaceuticals Pricing Board Expert Group (recommendations)75
  • Pharmaceuticals
    • – Outpatient76

  • Provide as publicly insured service (reimbursable)76

  • Do not provide as publicly funded service (nonreimbursable)76

 Yes76 Yes76 Yes77 Yes73 Yes73 No74
France

  • Ministry for Health and Social Security (decisions)20,78

  • French National Authority for Health (recommendations)78
  • Pharmaceuticals
    • – Outpatient
    • – Inpatient79

  • Devices79

  • Procedures79

  • Provide as publicly insured service (reimbursable)80

 Yes16,20,22,78 Yes16,20,22,78 Yes20 Yes20 Yes20 Yes16,20
Germany

  • Federal Joint Committee (decisions)19

  • Institute for Quality and Efficiency in Health Care (recommendations)19
  • Pharmaceuticals
    • – Outpatient
    • – Inpatient81,82

  • Devices18

  • Procedures83

  • Provide as publicly insured service (reimbursable)55

  • Do not provide as publicly funded service (nonreimbursable)55


Note: Must not exclude technologies for which there is no alternative18,81 		Yes19 Yes82,84 Yes19 Yes19 Yes19 Yes19
Greece

  • Transparency Committee in the Reimbursement and Medicinal Products (makes decisions)85,86
  • Pharmaceuticals
    • – Outpatient85

  • Classify pharmaceutical into therapeutic category85

 Yes85 Yes87 N/A N/A N/A N/A
Hungary

  • Ministers of Health and Finance (decisions)

  • National Health Insurance Fund Administration Health Technology Assessment Committee (recommendations)88,89
  • Pharmaceuticals
    • – Outpatient
    • – Inpatient90

  • Provide as publicly insured service88

  • Do not provide as publicly funded service (nonreimbursable)26

 Yes88 Not specified Yes90 Yes90 Yes90 Not specified
Ireland

  • Health Service Executive (decisions)91,92
  • Pharmaceuticals
    • – Outpatient
    • – Inpatient

  • Devices

  • Procedures91,92

  • Provide as publicly insured service (reimbursable)92

 Yes91 No91 Yes91 Yes91 Yes91 No93
Italy

  • Italian Medicines Agency Technical Scientific Committee (decisions)94

  • Italian Medicines Agency Pricing and Reimbursement Committee (recommendations)95
  • Pharmaceuticals
    • – Outpatient
    • – Inpatient21

  • Provide as publicly insured service (reimbursable)21

 Yes96,97 Yes96,97 Yes96 Yes96 Yes96 Yes96
Norway

  • Norwegian Medicines Agency (decisions)98

  • Department of Pharmacoeconomics (recommendations)98
  • Pharmaceuticals
    • – Outpatient
    • – Inpatient34

  • Provide as publicly insured service (reimbursable)98

 Yes98 Yes98 Yes98 Yes98 Yes98 Not specified
Poland

  • Ministry of Health (decisions)99
  • Pharmaceuticals
    • – Outpatient
    • – Inpatient100

  • Provide as publicly insured service (reimbursable)100

 Yes100 Yes100 Yes100 Yes100 Yes100 Not specified
Portugal

  • Ministry of Health (decisions)

  • INFARMED (recommendations)44,101
  • Pharmaceuticals
    • – Outpatient
    • – Inpatient102

  • Provide as publicly insured service (reimbursable)44

 Yes103 Yes99 Yes99 Yes99 Yes99 No99
Scotland

  • National Health Service Scotland (decisions)30

  • Scottish Medicines Consortium (recommendations)
  • Pharmaceuticals
    • – Outpatient
    • – Inpatient30

  • Provide as publicly insured service (reimbursable)30

 Yes104 No104 Yes104 Yes104 Yes99 No99
Slovakia

  • Ministry of Health (decisions)

  • Reimbursement Committee for Medicinal Products (recommendations)105–107
  • Pharmaceuticals
    • – Outpatient
    • – Inpatient102

  • Provide as publicly insured service (reimbursable)102

  • Do not provide as publicly funded service (nonreimbursable)102

 Yes106 Yes106 Yes102 Yes102 Yes102 Not specified
Spain

  • Ministry of Health Directorate General of Pharmacy and Health Products (decisions)21,108
  • Pharmaceuticals
    • – Outpatient
    • – Inpatient108

  • Provide as publicly funded service (reimbursable)108

  • Do not provide as publicly funded service (non-reimbursable)108

 Yes21 Yes21 Yes21 Yes21 Yes21 No21
Sweden

  • Dental and Pharmaceutical Benefits Board (decisions)15,109,110
  • Pharmaceuticals
    • – Outpatient

  • Devices (for administration of pharmaceuticals)15,21,33,109

  • Provide as publicly funded service (reimbursable)15

 Yes111 Yes112 Yes109 Yes109 Yes109 Yes109
Switzerland

  • Swiss Federal Office of Public Health (decisions)

  • Federal Drug Commission (recommendations)113–115
  • Pharmaceuticals
    • – Outpatient
    • – Inpatient113

  • Provide as publicly funded service (reimbursable)113

 Yes113,114 Yes113,114 Yes113,114 Yes113,114 Yes113,114 Not specified
The Netherlands

  • Ministry of Health, Welfare and Sport (decisions)

  • Medicinal Products Reimbursement Committee of the Dutch Healthcare Insurance Board (recommendations)116
  • Pharmaceuticals
    • – Outpatient
    • – High cost Inpatient49

  • Procedures117

  • Provide as publicly funded service (reimbursable)49

 Yes117,118 No31 Yes31 Yes31 Yes119 Yes119
United Kingdom

  • National Institute for Health and Clinical Excellence (decisions)

  • Technology Appraisals Committee (recommendations)7
  • Pharmaceuticals
    • – Outpatient
    • – Inpatient7

  • Devices7

  • Procedures7

  • Provide as publicly funded service (reimbursable)7

 Yes7 No7 Yes7 Yes7 Yes7 Yes7
Wales

  • Ministry for Health and Social Services (decisions)

  • All Wales Medicines Strategy Group (recommendations)120
  • Pharmaceuticals
    • – Outpatient
    • – Inpatient120

  • Provide as publicly funded service (reimbursable)120

 Yes120 No120 Yes120 Yes120 Yes120 Yes120