Understanding the interconnected landscape of payer types in the European healthcare environment

By Dr. Nick Proctor, expert-trainer of the Understanding Pharma Market Access & Payers in Europe course.
 

In the complex landscape of healthcare reimbursement in Europe, understanding the hierarchy and interconnection between different payer types is crucial to optimise market access. From national to local levels, each payer type plays a distinct role in shaping access to medical treatments and therapies. In this article, CELforPharma faculty member Dr. Nick Proctor delves into the hierarchy, decision-making processes, and interplay between various payer types.
 

• National Payers: Setting the Standards
  At the apex of the hierarchy are national payers, wielding significant influence over reimbursed access to the market. They establish the overarching rules governing market entry, requiring some combination of robust evidence of effectiveness, and cost. Communication is normally by formal submission and process-driven negotiation. Equipped to handle sophisticated data and each with their own particular analysis needs, national payers form the backbone of market access frameworks within Europe.
   
• Regional Payers: The Power of Decentralisation
  With historically strong subnational political authorities, and strong healthcare decentralization in several European countries, regional payers emerge as pivotal actors. Their importance lies in their ability to tailor healthcare provision to their local social and political priorities by developing regional formularies, often in alignment with national standards. Despite their regional focus, these payers possess the capacity to engage with complex data, ensuring localised healthcare needs are met effectively.
   
• Local/Hospital Payers: Bridging the Gap
  Operating at the grassroots level, local and hospital payers wield influence within community settings and healthcare institutions. As members of formulary committees, clinicians, pharmacists, and administrators, they make decisions closely tied to budget constraints and patient care. While they may lack familiarity with sophisticated data, their proximity to frontline healthcare delivery results in a nuanced understanding of practical needs.
   
• Patient Payers: A Shift in Dynamics
  Typically, patients in Europe are relegated to a peripheral role in reimbursement decisions. But, while not directly influencing market access, some direct or indirect financial burden underscores the importance of patient-centric approaches in healthcare policy and decision-making.

Diversity in Decision-Making

The decision-making processes among payer types exhibit diversity in membership, expertise, and political dimensions. National payers, often comprising non-healthcare professionals, contrast with regional and local counterparts where healthcare expertise is more prevalent. Additionally, the political dimension holds sway in regional contexts, reflecting the intersection between healthcare and governance.
 

Interconnection and Collaboration

Despite their distinct spheres of influence, payer types frequently intersect and collaborate. Regional payers and their advisors may engage at the national level, amplifying their impact on policymaking. Similarly, hospital and local payers may participate in regional structures, facilitating coordination across different levels of the healthcare system.

Navigating the complex web of payer types in Europe requires a nuanced understanding of their hierarchy, decision-making processes, and interconnectedness. By recognising the distinct roles and contributions of national, regional, local/hospital, and patient payers, stakeholders can foster collaboration and innovation, ultimately enhancing access to quality healthcare.