title: Device therapy and hospital reimbursement practices across European countries: a heterogeneous scenario.
abstract: As in other settings, in the field of clinical use of cardiac implantable electrical devices (CIEDs), the implementation, in various ways, of diagnosis-related groups (DRGs) has created new scenarios in most European healthcare systems. A DRG system is primarily a financial tool with the aim of promoting efficiency and improving utilization of resources. However, there are a variety of ways in which this system is used for funding the activity of centres implanting CIEDs. It is possible that the specific type and method of reimbursement may influence the implementation of CIEDs in the 'real world' through a variable spectrum of practices. These may range from the situation where reimbursement may, together with other factors, constitute a true barrier to the implementation of guidelines, to scenarios where reimbursement is adequate, and/or to situations where reimbursement may be adequate for standard devices but not for prompt implementation of effective technological innovations. The variety in reimbursement also affects how in-office checks of CIEDs are covered and, above all, the possibility to pay for remote follow-up of CIEDs. In the field of medical devices, refinement of DRG systems and adoption of new strategies and policies are needed to sustain and enhance those effective technological innovations that may be beneficial for specific patient populations. It is also important that physicians are deeply involved in the development and deployment of DRGs, and that each country DRGs agency has a transparent approach to engagement with stakeholders, along with robust and transparent mechanisms for updating these systems.
authors.affiliation: Institute of Cardiology, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy. giuseppe.boriani@unibo.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Boriani
authors.forename: Haran
authors.initials: H
authors.lastname: Burri
authors.forename: Lorenzo G
authors.initials: LG
authors.lastname: Mantovani
authors.forename: Nikos
authors.initials: N
authors.lastname: Maniadakis
authors.forename: Francisco
authors.initials: F
authors.lastname: Leyva
authors.forename: Joseph
authors.initials: J
authors.lastname: Kautzner
authors.forename: Andrzej
authors.initials: A
authors.lastname: Lubinski
authors.forename: Frieder
authors.initials: F
authors.lastname: Braunschweig
authors.forename: Werner
authors.initials: W
authors.lastname: Jung
authors.forename: Ignacio F
authors.initials: IF
authors.lastname: Lozano
authors.forename: Giovanni
authors.initials: G
authors.lastname: Fattore
mesh_terms: D001145:Arrhythmias, Cardiac / Q000191:economics* / Q000517:prevention & control*; D058409:Cardiac Resynchronization Therapy Devices / Q000191:economics*; D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care / Q000191:economics; D003953:Diagnosis-Related Groups / Q000191:economics*; D005060:Europe / Q000453:epidemiology; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics*