Détermination du ticket modérateur en fonction de la valeur sociétale de la prestation ou du produit
Authors: Cleemput Irina , Devos Carl , Devriese Stephan , Farfan-Portet Maria-Isabel , Van de Voorde Carine 
Published: January 2025

SYNTHÈSE 9 -- 1. CONTEXTE 9 -- 2. DÉFINITION ET OBJECTIFS DE LA VALUE-BASED INSURANCE 10 -- 3. FORMES DE VALUE-BASED INSURANCE 11 -- 4. IMPACT DE LA VALUE-BASED INSURANCE 12 -- 5. PROBLÉMATIQUES DE LA VALUE-BASED INSURANCE 13 -- 5.1. CONDITIONS ET OBSTACLES À LIMPLÉMENTATION DUNE VBI 13 -- 5.2. « VALUE-BASED INSURANCE » VERSUS « VALUE-BASED PRICING » 14 -- 5.3. LOPINION PUBLIQUE EST-ELLE FAVORABLE À UNE VBI ? 15 -- 5.4. VALUE-BASED INSURANCE ET TICKET MODÉRATEUR SOUS LA FORME DUN MONTANT FIXE OU DUN POURCENTAGE 15 -- 6. ILLUSTRATION DUNE POSSIBLE APPLICATION DES PRINCIPES DE LA VALUE-BASED INSURANCE AUX MÉDICAMENTS ET IMPACT BUDGÉTAIRE 16 -- 7. CONCLUSION 18 -- SCIENTIFIC REPORT 19 -- 1. INTRODUCTION 19 -- 1.1. GENERAL BACKGROUND 19 -- 1.2. SCOPE AND RESEARCH QUESTIONS 20 -- 1.3. METHODS 20 -- 1.4. CONTENT OF THE REPORT 20 -- 2. THE ROLE OF DEMAND-SIDE COST SHARING IN A SOCIAL INSURANCE SYSTEM 21 -- 2.1. DIMENSIONS OF HEALTH INSURANCE COVERAGE 21 -- 2.1.1. Breadth of the coverage 21 -- 2.1.2. Depth of the coverage 21 -- 2.1.3. Height of the coverage 21 -- 2.2. A BRIEF INTRODUCTION ON OPTIMAL COST SHARING 22 -- 2.2.1. Cost shifting 22 -- 2.2.2. Fighting moral hazard... 22 -- 2.2.3. Steering behaviour of imperfectly informed patients 23 -- 2.3. HEALTH INSURANCE COVERAGE AND VALUE-BASED INSURANCE 23 -- 2.4. DIFFERENTIATED COST SHARING IN BELGIUM 23 -- 2.4.1. Disease management programme for type 2 diabetes 23 -- 2.4.2. Pharmaceuticals 24 -- 2.4.3. Healthcare services 27 -- 3. THE CONCEPT OF VALUE-BASED INSURANCE 27 -- 3.1. THE BASIC PRINCIPLE OF VALUE-BASED INSURANCE 27 -- 3.2. DEFINITION OF VALUE 28 -- 3.2.1. Value in value-based insurance 28 -- 3.2.2. Value-based pricing 29 -- 3.2.3. Value in value-based pricing 30 -- 3.2.4. Issues with value-based pricing in practice 30 -- 3.2.5. Value-based insurance when value-based pricing fails 31 -- 4. TYPES OF VALUE-BASED INSURANCE DESIGNS 35 -- 4.1. DESIGNS IN GENERAL 35 -- 4.2. VALUE-BASED INSURANCE DESIGNS IN FUNCTION OF THE TYPE OF SERVICE 39 -- 4.2.1. One size does not fit all 39 -- 4.2.2. Belgian examples 41 -- 5. ISSUES IN VALUE-BASED INSURANCE 43 -- 5.1. VALUE-BASED INSURANCE AND SOCIAL PROTECTION 43 -- 5.2. VALUE-BASED INSURANCE AND COINSURANCE VERSUS CO-PAYMENT 43 -- 5.3. CONDITIONS FOR IMPLEMENTING VALUE-BASED INSURANCE 45 -- 5.3.1. Evidence on the value of healthcare services 45 -- 5.3.2. Efficient targeting 46 -- 5.3.3. Data requirements 47 -- 5.3.4. Auditing 47 -- 5.3.5. Patient and physician information 47 -- 5.3.6. Integrated approach 48 -- 5.4. PUBLIC ACCEPTANCE AND SUPPORT FOR VALUE-BASED INSURANCE 48 -- 6. IMPACT OF VALUE-BASED INSURANCE 49 -- 6.1. EXPECTED BENEFITS OF VALUE-BASED INSURANCE 49 -- 6.1.1. Impact on adherence... 49 -- 6.1.2. Impact on healthcare expenditures 50 -- 6.1.3. Impact on access to healthcare 50 -- 6.2. REAL-LIFE EXPERIENCES IN THE US 51 -- 6.2.1. Value-based co-payment tiers for pharmaceuticals 51 -- 6.2.2. Costs and outcomes of value-based insurance designs 52 -- 6.3. EVALUATION OF VALUE-BASED INSURANCE DESIGNS IN BELGIUM 57 -- 7. ILLUSTRATION OF A POSSIBLE APPLICATION OF VALUE-BASED INSURANCE PRINCIPLES TO ANTIDEPRESSANTS... 58 -- 7.1. OBJECTIVE AND SCOPE 58 -- 7.2. INDICATIONS FOR ANTIDEPRESSANTS 59 -- 7.2.1. Severe depression 59 -- 7.2.2. Label extensions 59 -- 7.2.3. Off-label use 59 -- 7.3. USE OF ANTIDEPRESSANTS 60 -- 7.3.1. Volume increase 60 -- 7.3.2. Antidepressant treatment duration and non-persistence 60 -- 7.4. SIMULATION OF A VALUE-BASED INSURANCE DESIGN FOR ANTIDEPRESSANTS 61 -- 7.4.1. Microsimulation as a tool for the analysis of policy measures 61 -- 7.4.2. Description of the data 61 -- 7.4.3. Analysis sample 62 -- 7.4.4. Defining a treatment episode 64 -- 7.4.5. Social protection measures 65 -- 7.4.6. Simulation scenarios 65 -- 7.5. RESULTS OF THE BASELINE SITUATION 67 -- 7.6. RESULTS OF THE SIMULATED SCENARIOS 71 -- 7.7. DISCUSSION 76 -- 7.7.1. Appropriateness and feasibility of a higher patient cost sharing for a first prescription 76 -- 7.7.2. Shared responsibilities 77 -- 8. CONCLUSION 77 -- APPENDICES 79 -- REFERENCES 119 --