PhD defence S. (Sanne) Allers

Brief summary:

Innovation seems to hold infinite promise for healthcare to keep up with developments in society and increasing healthcare costs. Think about technologies being able to keep organs alive outside the body, or the transformation of nurse specialists who are able to diminish the burden on healthcare personnel. Yet, for this promise to come to fruition, valuable innovations must proceed from being an initial idea to being used in healthcare. One of the factors potentially influencing innovations’ progress is payment. The central aim of this dissertation is to improve the understanding of the role of payment in healthcare innovation processes.

This dissertation includes five studies: (a) a systematic review of the literature, (b) a qualitative case study of medical devices and health information technology tools to infer the facilitating and impeding effects of payment on product innovation, (c) a second set of case studies, focusing on four projects aiming to integrate care processes, (d) a cross-disciplinary (theoretical) analysis to understand the complexities encountered in attempts to scale-up innovative eHealth tools beyond their local settings, and (e) a Delphi study assessing which financial barriers are perceived as most urgent and which solutions are deemed most promising.

We conclude that the predominant focus of current payment mechanisms – rewarding innovations with the largest potential to sell, make a profit for the payer, or result in the largest savings – is not directed at creating value for health or society. Lessons from this dissertation emphasize (i) the importance of implementing a (more) flexible payment system in healthcare; (ii) introducing more explicit priority-setting of health and societal values in payment mechanisms; (iii) collaboration between different payers and maintaining a comprehensive view on the innovation process; (iv) reserving financial wiggle room to protect the opportunity for innovation; (v) increasing opportunities for scaling valuable innovations beyond their local setting; and (vi) creating strategies to address the (financial) losses involved with innovation. Finally, we urge decisionmakers, care providers and innovators to push for a change in the right direction, switching the focus from commercial value towards value for health and society.