Digital health reimbursement strategies of 8 European countries and Israel: scoping review and policy mapping

Background: The adoption of digital healthcare within health systems is determined by various factors, including pricing and reimbursement. The reimbursement landscape for digital health in Europe remains under-researched. While various emergency reimbursement decisions were made during the COVID-19 pandemic to allow the use of healthcare delivery through videoconferencing and asynchronous care (e.g., digital applications), research so far has primarily focused on the policy innovations that facilitated this outside of Europe. Objective: This article examines the digital health reimbursement practices in eight European countries (Belgium, France, Germany, Italy, the Netherlands, Poland, Sweden, and the United Kingdom) and Israel. Methods: A policy mapping analysis was performed using a scoping review as foundational methodology. We reviewed the literature in MEDLINE, Embase, Global Health, and Web of Science. Supplementary records were identified through Google Scholar and country experts. Results: Our search strategy yielded a total of 1559 records, of which 40 were ultimately included in this article. As of August 2023, digital health solutions are reimbursable to some extent in all studied countries except Poland, though the mechanism of reimbursement differs significantly across countries. At the time of writing, pricing of digital health solutions are mostly determined through discussions between national or regional committees and the manufacturers of digital health solutions in absence of value-based assessment mechanisms. Financing digital health solutions outside traditional reimbursement schemes was possible in all studied countries except Poland and typically occurrs via health innovation or digital health-specific funding schemes. European countries show value-based pricing frameworks that range from non-existent to embryonic. Conclusions: Studied countries show divergent approaches to the reimbursement of digital health solutions. These differences may complicate the ability of patients to seek cross-country healthcare in another country, even if a digital health application is available in both countries. Further, the fragmented environment will present challenges for developers of such solutions, as they look to expand their impact across countries and health systems. An increased emphasis on developing a clear conceptualisation of digital health, as well as value-based pricing and reimbursement mechanisms, are needed for the sustainable integration of digital health. This paper can therein serve as a basis for further, more detailed research as the field of digital health reimbursement evolves.