A FIVE-DIMENSIONAL CONCEPTUAL FRAMEWORK FOR ANALYSING PAYMENT MODELS FOR DIGITAL HEALTH TECHNOLOGIES: DEVELOPMENT AND EXPERT VALIDATION
Author(s)
Yelena Khegay, MD, MPH, MSc1, Zoltan Kalo, PhD2, Sándor Kovács, BA, MBA, MSc1, Thi Phuong Thao Nguyen, MD, MSc1.
1Semmelweis University; SYREON Research Institute, Budapest, Hungary, 2National Health Insurance Fund, Hungary, Budapest, Hungary.
1Semmelweis University; SYREON Research Institute, Budapest, Hungary, 2National Health Insurance Fund, Hungary, Budapest, Hungary.
OBJECTIVES: Digital health technologies (DHTs) with demonstrated clinical benefit frequently fail to achieve sustainable market adoption due to innovators' limited understanding of healthcare payment logic. Existing literature extensively discusses national reimbursement pathways but lacks a structured, cross-comparable way for analyzing payment models. This study aimed to develop and validate a conceptual framework for breaking down payment arrangements for DHTs across various health system contexts.
METHODS: A multi-method qualitative approach was used: (1) an umbrella review of systematic reviews (PubMed, Scopus; 2015-2026) synthesising payment arrangements across six eligible publications; (2) iterative framework development using a hybrid deductive-inductive approach; and (3) structured expert validation with payers and health technology assessment specialists from thirteen countries across Central and Eastern Europe, Kazakhstan, and the Middle East.
RESULTS: The umbrella review revealed recurrent structural dimensions across diverse payment arrangements: the identity of the payer, the payment mechanism, the payment recipient, payment conditionality, and payment timing. These five dimensions, present explicitly or implicitly in all existing arrangements, regardless of jurisdiction or technology type, were further used to form a conceptual framework. Expert consultation verified the framework's clarity, completeness, and cross-contextual applicability. Additionally, the operational importance of distinguishing between payment for the DHT itself and payment for healthcare services delivered through it was highlighted.
CONCLUSIONS: The five-dimensional framework provides a stable conceptual structure for comparing, selecting, and communicating payment models for DHTs, independent of health system context and technology category. It supports the deliberate selection of a payment model from the early stages of product development and positions financing strategy as a core component of early health technology assessment.
METHODS: A multi-method qualitative approach was used: (1) an umbrella review of systematic reviews (PubMed, Scopus; 2015-2026) synthesising payment arrangements across six eligible publications; (2) iterative framework development using a hybrid deductive-inductive approach; and (3) structured expert validation with payers and health technology assessment specialists from thirteen countries across Central and Eastern Europe, Kazakhstan, and the Middle East.
RESULTS: The umbrella review revealed recurrent structural dimensions across diverse payment arrangements: the identity of the payer, the payment mechanism, the payment recipient, payment conditionality, and payment timing. These five dimensions, present explicitly or implicitly in all existing arrangements, regardless of jurisdiction or technology type, were further used to form a conceptual framework. Expert consultation verified the framework's clarity, completeness, and cross-contextual applicability. Additionally, the operational importance of distinguishing between payment for the DHT itself and payment for healthcare services delivered through it was highlighted.
CONCLUSIONS: The five-dimensional framework provides a stable conceptual structure for comparing, selecting, and communicating payment models for DHTs, independent of health system context and technology category. It supports the deliberate selection of a payment model from the early stages of product development and positions financing strategy as a core component of early health technology assessment.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HTA79
Topic
Economic Evaluation, Health Policy & Regulatory, Health Technology Assessment
Topic Subcategory
Systems & Structure, Value Frameworks & Dossier Format
Disease
No Additional Disease & Conditions/Specialized Treatment Areas