Reimbursement of digital health solutions is an investment in citizens’ health and the economy

Bridging the gap between current reimbursement models and technological advancements is critical to making digital innovation accessible to those who need it most.

Why digital health is just health

I’m fortunate to live in a country where I have access to diagnostics, therapies, and medicines as part of a comprehensive healthcare system. While it’s far from perfect, the system ensures that citizens receive the care they need through health insurance.

And what about the care provided digitally? Digital health solutions are no longer an add-on; they can enable citizens to manage health, prevent disease, and improve well-being. Unfortunately, despite growing evidence, they are still predominantly funded through out-of-pocket patient payments.

I know we are in the early days of digital health solutions. But I believe this approach must change. Whether it’s an active pharmaceutical ingredient or a digital tool that offers clear benefits to patients and is safe, it should be made accessible to everyone.

Far-reaching consequences of financial models in healthcare

The past year has seen significant advancements in reimbursement models for digital tools. Yet, considering the extensive evidence supporting these innovations, it’s just a drop in the ocean.

According to the recent report Going digital for non-communicable diseases by the World Health Organization, an additional $0.24 per patient per year invested in telemedicine and digital health could, over a decade, save over 2 million lives, add 5 million life-years, and avert 7 million acute events and hospitalizations, yielding $199 billion in economic benefits.

In other words, delays in implementing reimbursement models for digital health solutions create a domino effect—the digital divide contributes to missed health and economic opportunities that exacerbate socioeconomic inequalities.

Redefining patient outcomes

Recently, I had an inspiring conversation with Afua van Haasteren, PhD , Roche Diagnostics’ Director of Health Policy & External Affairs. She noted that “reimbursement and innovative funding models are crucial for financing the launch of new tools. Moreover, they provide a framework to ensure digital health solutions are sustainable, scalable, and seamlessly integrated into real-world settings.” I couldn’t agree more.

Reimbursement remains fragmented. New fast-track models for public financing of digital health solutions, such as Germany’s DiGA and France’s Pecan, share similar objectives but impose different requirements for the inclusion of digital health solutions. Innovators must apply separately in each country. In the UK, the NICE framework provides standards for digital health technologies but doesn’t guarantee reimbursement. Approaches to health technology assessment and regulation of digital therapeutics (DTx) vary across countries.

Additionally, many reimbursement approaches focus solely on direct patient outcomes, leaving physician-oriented tools disadvantaged. For example, clinical decision support systems (CDSS) or tools that improve provider efficiency and reduce workload often don’t meet the “patient benefit” criteria. However, they clearly impact care quality, offering an indirect but tangible benefit to patients.

This disconnect shows the need for an approach that reflects the evolving nature of digital tools—a static approval process is inadequate. Dr. van Haasteren suggests a fit-for-purpose approval process that takes the breadth and variation of digital solutions into account and prioritizes the need for sustained user engagement.

Closing the digital divide

Developing standardized reimbursement models for digital health solutions will be challenging, but the longer we wait, the harder it will get.

The regulatory framework already lags behind technological advances, and with novel innovations like artificial intelligence (AI), spatial computing, or the metaverse, the gap will keep growing. According to a study, A scoping review and expert consensus on digital determinants of health, 37 of 127 health determinants are already digital.

We need a unified, value-based approach that integrates regulatory, evaluative, and reimbursement frameworks, simplifying the path for manufacturers, clarifying processes for providers, ensuring digital tools reach patients, and shifting the focus to value-based care.

Reimbursement is a bridge to equitable healthcare

Adapting existing reimbursement and financing models to the digital era is crucial for making healthcare affordable and accessible; it is essential in order to align the healthcare system with technological advancements. Beyond improving health and well-being, the new approaches will strengthen local innovation ecosystems, enhance data sovereignty, and stimulate the digital economy.

To me, it's also a responsibility to future generations. We must do everything we can to ensure they have access to the best care through modern, up-to-date healthcare systems.