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Biodesign by Paul Yock, Josh Makower, Stefanos Zenios

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4.3 Reimbursement Basics

Introduction
Patients interested in a new technology or treatment; doctors committed to delivering it: in most industries, this would be a formula for success. But in the healthcare field, one critical factor is missing: the role of payers, or those third-party private or public insurance companies that make the decisions whether or not to pay for (or reimburse) a new medical device. With healthcare costs escalating and few patients able to afford their own medical expenses without insurance coverage, payers (through their reimbursement decisions) are exercising unprecedented levels of influence and control over the adoption of new technologies and, in turn, the direction of patient care.
The purpose of reimbursement ...

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