From: Gustav Kovac, For: Claude Cohen, Stelios Chatzi, Augusto Machado, Pierre Langlois, Per Hyltoft Petersen, Wytze Oosterhuis, Matthias Orth, Gabor Kovacs, Attilla Miszeta
Date: 2. 5. 2017
Introduction
The goal for comparison was to gain an overview on most frequently used clinical laboratory tests in countries throughout the EU.
Method
Appeal for Cooperation
From: prof MUDr RNDr Gustav Kovac CSc MBA To: Members of Section and Board for Laboratory Medicine UMES
Date: 16. 2. 2017
Introduction
Slovak Society for Laboratory Medicine ( SSLM ) prepares for negotiations with Slovak Health Insurance Companies on Revision of Reimbursement fees for laboratory tests
Method
one of the basic prerequisites for being good prepared is the knowledge on reibursement fees in other countries in the EU
Result
we are asking you to provide us with information on reimbursement fees for 20 most frequent laboratory tests in Slovakia ( see the attached file
Discussion
the negotiations are planned to start at 6th March 2016
SSLM would be happy to receive the support from members / representatives of the section and board for Laboratory Medicine UEMS – if possible
Conclusion
Help us in that you fill out the table in the attached file – if posible, please
Reccommendations
for any question or comments use
Table
Results
Discussion
COMMENTS FROM PARTICIPANTS PROVIDING REIMBURSEMENT FEES
France ( Claude Cohen )
These prices are public however, it is necessary to remain careful and not to spread them beyond those who participated in it.
Greece ( Stelios Chatzi )
The prices are form the official website of the Ministry of Health. They are now up to revise fee-list in terms of rationalization: some prices are higher and some are lower than they should be.
Portugal ( Augusto Machado )
The whole fee for services catalogue and explanation directive has been promptly provided. Interesting is, for each test has the patient to pay approximately 10-20% of total price. The rest is payed from the state / health insurance company
Belgium ( Michel Langlois )
Belgium representative ( EFLM ) provided required data promptly
Sweden ( Per Hyltoft Petersen )
Two lists of prices from two counties in the South of Sweden (Blekinge and Halland). The Swedish currency: 9.5 kronor corresponds to approximately 1 Euro. The prices from the two counties are not identically, e.g. Serum Ca and serum Albumin cost 15.36 kr in Blekinge and 5 kr in Halland, IgG, IgA and IgM are close 23.55 and 26 kr, and serun testosterone 107.00 and 60 kr.
The Netherlands ( Wytze Oosterhuis )
Whole list of more than laboratory tests and reimbursement fees has been provided. It contains approximately more than 400 laboratory tests in consolidatet form. It could be taken as a model for simplification of laboratory test catalogue in Slovakia.
Germany ( Matthias Orth )
EBM2000 (Einheitlicher Bewertungsmassstab -- uniform valuation schedule) Subtract 10% of the prices for the real reimbursement, right now they are trying to get payment down to only 80% of the prices in the list (which ist 20 Cent for a clinical chemistry test including HDL and LDL). The GOÄ (Gebührenordnung für Ärzte -- Physicians' tariff) is a law. Everything is paid in points (a point is worth 0.059 Cent) and you are allowed to increase the price by a factor (which is 1.15 but in some case the factor is only 0.8 so actually the payment gets lower when the "increasing factor" is applied).
The lab tests have the numbers 3500-4787. Use the points for comparison, the prices given in the law in the last columng are still in German Marks (2 German Marks DM are about 1 EUR). Enclosed are more tests with our different tariffs. This figure compares Theranos pricing with EBM2000 and GOÄ.
When it comes to put money behind certain tests, it is rather critical to look at the whole picture. In clinical chemistry, nobody can survive from a reimbursement of 0.22 Cent for LDL or HDL (the reagent is by far more expensive and the technicians also ask for their paycheck). In Germany the whole calculation is based on CRP and on some rather frequent tests (like Vitamin D). In addition, if they have only few patients which get invoices after GOÄ this will also compensate for the losses in EBM2000.
My suggestion is to look for the tests which generate ~80% of your revenues (in our labs these are about 200 different tests) and then look for the effects of changes in reimbursement. It is rather
dangerous to present the lowest costs among different countries -- then there will be no way to compensate for the losses. By the way, the prices of Theranos were multifold higher than our EBM2000.
Hungary ( Gabor Kovacs, Attilla Miszetta )
The similar informations on reimbursement fees provided promptly from two sources
PARTICIPANTS PROVIDING ONLY COMMENTS
UK ( Ian Watson )
The UK does not have a reimbursement based system for laboratory tests. The Government believe that pathology should cost 1.6% of a hospital’s budget, this includes providing services to the community. This makes no allowance for anything other than routine tests. The Carter Report on pathology had ‘baskets of tests’ based on cost, but this is 10 years old and probably not relevant to us.
Denmark ( Per Hyltoft Petersen )
It seems to be rather difficult to get the information on reimbursement fees.
Finland ( Ilkka Mononen )
In Finland the test prices vary from lab to lab. In the public sector, the lab test prices are included in the flat fee that the patient pays for the visit to the doctor. In the private sector, the patients pays for both the lab tests and the visit to the doctor and the fees vary from one service provider to another. Depending on the situation, the patient may get some reimbursement from the government from the private sector costs.
Wales ( Ian Frayling )
The Wales representative is on sabbatical leave until end of April.
Italy ( Francesco Verna )
Health care system in Italy is decentralized: each region has it’s own rules. That is valid also for the reimbursement. Up to that time no information was available
Conclusion
1 On the comparison / cooperation study participated 14 EU Countries ( from 28 countries asked )
9 provided information on reimbursmenet fees and comments ( France, Greece, Portugal, Belgium, Sweden, The Netherlands, Germany, Slovakia, Hungary )
5 provided only comments on reimbursement systems ( UK, Danmark, Finland, Wales, Italy )
2 38 most frequently tests used in Slovakia were evaluated
3 The average ( non weighted ) reimbursement fee for 1 laboratory test for EU is 3,26 EUR 4 The avergae ( non weighted ) reimbursement fees for individual conuntry
France [ 5, 71 EUR ]
Greece [ 4,90 EUR ]
Portugal [ 4,71 EUR ]
Belgium [ 3,96 EUR ]
Sweden [ 2,90 EUR ]
Netherlands [ 2,78 EUR ]
Sweden [ 2,40 EUR ]
Germany [ 1,98 EUR ]
Slovakia [ 1,69 EUR ]
Hungary [ 1,55 EUR ]
5 The „Test Categories“
1 EUR Tests Category ( „Routine Chemistry“ )
creatitine, AST, glucose, GGT, ALT, urea, sodium, potassium, bilirubin, cholesterol, triglycerides, alkaline phosphatase, chloride, uric acid, calcium, total protein
2 EUR Tests Category ( „Special Chemistry“ )
LDL, HDL, uric acid, total protein
4 EUR Tests Category ( „Hematology, Microscopy“ )
CRP, fibrinogen, urine sediment, IgG, IgA, IgM, APTT, fibrinogen, CBC 3-5
8 EUR Tests Category ( „Immunoserology“ )
hepatitis, treponema, HIV, ANA, ENA, IgE
10 EUR Tests Category ( „Molecular Biology“ )
DNA, transglutaminase
Recommendations
1 Proposal for further steps
Discussion on comming UEMS LM Section and Board meeting in Faro
Test catalogue consolidation according and the Netherlands catalogue
Discussion on Portugal payment system
Increasing number of participants
2 Recommendation from Matthias Orth
look for the tests which generate 80% of revenues and then look for the effects of changes in reimbursement
it is rather dangerous to present the lowest costs among different countries - then there will be no way to compensate for the losses.