There is significant and growing interest among both the payers and producers of medical products for arrangements that involve a “pay-for-performance” or “risk-sharing” element. These payment schemes involve a plan by which the performance of the product is tracked in a defined patient population over a specified period and the level of reimbursement is tied by formula to the outcomes achieved. Although these agreements have an intrinsic appeal, there can be substantial barriers to their implementation. Theory and practice, including incentives and barriers, will be analyzed along with several country-specific examples including those from Asia Pacific. It will be helpful for individuals to be familiar with both the key determinants of pharmaceutical pricing and the main international health systems.
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