OBJECTIVES: Home care insurance market is growing with an annual rate of 18.3% globally. This market share will be driven by the aging population. Reimbursement is often limited to nursing support, while devices used for treating, monitoring or diagnosing patients at home is sometimes undermined. Aim of current study is to discuss the current framework, associated challenges and possible solutions for reimbursement of medical devices for home care.

METHODS: We conducted a targeted literature review to assess current scenarios and consulted with a selected group of experts for challenges and possible solutions.

RESULTS: In the USA, CMS has set clear policies for reimbursement of remote patient monitoring and telehealth solutions. However, private payers need to provide more clarity. In Europe, France has provision to reimburse novel remote monitoring. Physicians’ approval remains key in Belgium. Germany and Netherlands have mechanisms in place to reimburse home care medical devices in certain scenarios. Poland reimburses only digital health consultation. In Latin America, Brazil has provisions to reimburse diagnostics, while in Mexico both diagnostics and devices are reimbursed for home care. In Asia, Korea and Australia have either rental reimbursement or complete telehealth or remote monitoring reimbursements.

Medical devices are heterogeneous group which require more clarity and uniformity around how payers categorize medical devices used for home care. Effective reimbursement pathways, consensus on evidence required, capacity challenges with payers and limited local data are major challenges. These can be addressed by favorable policy shaping, providing clarity around required evidence, allowing novel evidence generation approaches beyond randomized trials and establishing public-private partnership in certain countries.

CONCLUSIONS: Reimbursement frameworks for devices used for home care are evolving worldwide. More clarity around evidence needed to secure reimbursement is required. A wider panel including experts from HTA, manufacturer, payers and policy makers can recommend ways to develop more robust reimbursement frameworks.