Volume 8, Issue 1 (Spring 2025)
Iran J Health Insur 2025, 8(1): 1-16 |
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Almasi S, Moradi T, Rabiei R, Samadbeik M. Reimbursement of Digital Health Technologies in Selected Countries; A Comparative and Narrative Review. Iran J Health Insur 2025; 8 (1) :1-16
URL: http://journal.ihio.gov.ir/article-1-358-en.html
URL: http://journal.ihio.gov.ir/article-1-358-en.html
1- National Center for Health Insurance Research, Tehran, Iran , almasi.sohrab@gmail.com
2- National Center for Health Insurance Research, Tehran, Iran
3- Department of Health Information Technology and Management, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
4- Queensland Digital Health Center, Faculty of Health, Medicine and Behavioural Sciences, The University of Queensland, Brisbane, Australia
2- National Center for Health Insurance Research, Tehran, Iran
3- Department of Health Information Technology and Management, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
4- Queensland Digital Health Center, Faculty of Health, Medicine and Behavioural Sciences, The University of Queensland, Brisbane, Australia
Abstract: (1244 Views)
Introduction: Digital transformations in the health sector require innovative reimbursement mechanisms to expand access and improve the quality of these services. Therefore, the aim of this article is to examine the experiences of six leading and selected countries in the field of digital health technologies, along with an analysis of the challenges and opportunities along this path.
Methods: The method used in this research was a comparative approach in reviewing studies and documents from 2010 to 2025, conducted through searches in scientific databases such as Web of Science, Scopus, and PubMed, reputable scientific websites, international organizations, and official websites of the selected countries. Subsequently, for analysis of the results, a narrative review was conducted in five groups: reimbursement processes, evaluation criteria, pricing mechanisms, participating organizations, and covered technologies for each country.
Results: The findings show that each country, according to the structure of its health system, has a different approach. Germany with the DiGA system, Belgium with the mHealth pyramid, and France with the PECAN program are examples of structured European systems emphasizing clinical evidence collection and integration of digital technologies. In contrast, the United States, due to its decentralized system, has a diverse approach based on multiple payers (such as Medicare and private insurers) and lacks a unified national framework. Australia and South Korea are also developing reimbursement mechanisms with a focus on telemedicine and digital therapeutics. Common challenges include lack of standardized evaluations, complexity of reimbursement processes, and the need for strong clinical and economic evidence. However, there are also opportunities such as improved access to care, cost reduction, and increased efficiency of the health system.
Conclusion: Overall, this study demonstrates that despite structural differences, leading countries are developing appropriate frameworks for digital health reimbursement. Each country, based on its own conditions and structure, is testing and implementing different frameworks. Nevertheless, common challenges such as the need to generate sufficient evidence, ensure data safety and security, and design sustainable pricing models persist. Despite structural differences, the experiences of leading countries can provide valuable lessons for others in designing reimbursement systems for digital health technologies.
Methods: The method used in this research was a comparative approach in reviewing studies and documents from 2010 to 2025, conducted through searches in scientific databases such as Web of Science, Scopus, and PubMed, reputable scientific websites, international organizations, and official websites of the selected countries. Subsequently, for analysis of the results, a narrative review was conducted in five groups: reimbursement processes, evaluation criteria, pricing mechanisms, participating organizations, and covered technologies for each country.
Results: The findings show that each country, according to the structure of its health system, has a different approach. Germany with the DiGA system, Belgium with the mHealth pyramid, and France with the PECAN program are examples of structured European systems emphasizing clinical evidence collection and integration of digital technologies. In contrast, the United States, due to its decentralized system, has a diverse approach based on multiple payers (such as Medicare and private insurers) and lacks a unified national framework. Australia and South Korea are also developing reimbursement mechanisms with a focus on telemedicine and digital therapeutics. Common challenges include lack of standardized evaluations, complexity of reimbursement processes, and the need for strong clinical and economic evidence. However, there are also opportunities such as improved access to care, cost reduction, and increased efficiency of the health system.
Conclusion: Overall, this study demonstrates that despite structural differences, leading countries are developing appropriate frameworks for digital health reimbursement. Each country, based on its own conditions and structure, is testing and implementing different frameworks. Nevertheless, common challenges such as the need to generate sufficient evidence, ensure data safety and security, and design sustainable pricing models persist. Despite structural differences, the experiences of leading countries can provide valuable lessons for others in designing reimbursement systems for digital health technologies.
Type of Study: Review Article |
Subject:
Special
Received: 2025/04/19 | Revised: 2025/08/10 | Accepted: 2025/05/31 | ePublished: 2025/06/18
Received: 2025/04/19 | Revised: 2025/08/10 | Accepted: 2025/05/31 | ePublished: 2025/06/18
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