PHP191 Impact of a Financial Risk-Sharing Scheme on Budget-Impact Estimations: A Game-Theoretic Approach Academic Article uri icon

abstract

  • Objectives As part of the process of updating the National List of Health Services (NLHS) in Israel, both health-plans ('payers') and manufacturers provide estimates on the expected number of patients that will utilize the drug. Currently, payers face major financial consequences when actual drug utilization is significantly higher than the allocated budget. We suggest a risk-sharing model that imposes a potential penalty on the two stakeholders; if the actual number of patients exceeds the manufacturer's prediction, the manufacturer will reimburse the payers by a rebate rate of α from the deficit. In case of under-utilization, payers will refund the government at a rate of γ from the surplus budget. Our study objective was to identify the optimal early estimations of both 'players' prior to and after implementation of the risk-sharing scheme. Methods Using a Game-Theoretic approach, in which both players' …

publication date

  • January 1, 2012