Your clinical evidence is strong. UK payers are still saying no.
NHS commissioners and private insurers fund on health economics, not clinical outcomes alone. Without a UK-specific value case, even well-evidenced medtech stalls at the reimbursement stage indefinitely.
- steps
- 7
- steps
- to start
- 1 day
- to start
The short answer
Before you build a health economic model, decide who actually pays: a private medical insurer, the hospital or clinic from its own margin, the patient, or the NHS. Each needs a different case. In the private sector, a simple cost-consequence model in the provider's numbers, and a check that your procedure has a CCSD code and can be billed to insurers, often matter more than a QALY model.
7 steps
Do it yourself: step by step
0 of 7 done
For each customer type, write down who pays: insurer reimbursement, provider absorbs within an existing tariff or package price, patient self-pay, or NHS commissioner
- Time
- 1 day
- Typical cost
- £0
- Who does it
- Founder and commercial lead
Done when: One table naming the payer and their decision process per segment
This problem is Solvable.
Copy this table
Cost-consequence and budget impact table for a UK provider
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Who pays
| Segment | Who pays | How they decide | What they need to see |
|---|---|---|---|
| Private hospital (insured patients) | Insurer, or hospital within its agreed price | Insurer clinical and pricing teams; hospital finance | Billable episode, cost per episode, outcomes |
| Private hospital (self-pay packages) | Hospital from package margin | Hospital finance and medical advisory committee | Margin per package, throughput |
| Independent clinic | Clinic owner | Owner or practice manager | Payback period, staff time |
| NHS | Trust or commissioner | Business case, NICE where relevant | Cost-effectiveness, budget impact |
Cost-consequence per episode
| Item | Current pathway | With [product] | Difference | Source |
|---|---|---|---|---|
| Product or consumable cost | £[ ] | £[ ] | £[ ] | [Price list] |
| Theatre or procedure minutes | [ ] min at £[ ]/min | [ ] min | £[ ] | [Customer data] |
| Length of stay | [ ] nights at £[ ] | [ ] nights | £[ ] | [ ] |
| Readmission or complication rate | [ ]% at £[ ] | [ ]% | £[ ] | [Study] |
| Staff time | [ ] hours at £[ ] | [ ] hours | £[ ] | [ ] |
| Follow-up appointments | [ ] at £[ ] | [ ] | £[ ] | [ ] |
| Net per episode | £[ ] |
Budget impact over three years
| Year 1 | Year 2 | Year 3 | |
|---|---|---|---|
| Episodes per year | [ ] | [ ] | [ ] |
| Uptake | [ ]% | [ ]% | [ ]% |
| Cost of [product] | £[ ] | £[ ] | £[ ] |
| Savings or extra income | £[ ] | £[ ] | £[ ] |
| Net | £[ ] | £[ ] | £[ ] |
Assumptions log
| Input | Value | Source | Reviewed by |
|---|---|---|---|
| [ ] | [ ] | [Provider data / published / Solvable estimate] | [Name, date] |
Avoid these
Common mistakes
- Building a QALY model for a private hospital finance director who wants payback in months.
- Assuming insurers will pay without checking how the episode is coded and billed.
- Using your own assumptions for theatre and bed costs instead of the provider's.
- Presenting savings that land in a different budget from the one paying for your product.
- Writing one value case for every payer type.
Free personal check
Done by Paul Robinson, not software
I'll look at who pays for your device and tell you which value case you actually need
What I need from you
- Answers to 7 tap questions
- One line on what your device changes
What you get
- Who the real payer is in each segment
- Whether coding and insurer billing look like a risk
- The simplest model that would move your stalled deals
Within 2 working days
No sign-in, no sales call. I read every request myself and reply on WhatsApp.
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Check where you stand
Benchmarks
Tiered evidence by risk of the technology
NICE sets out the evidence expected for digital health technologies, including economic evidence, in its Evidence Standards Framework
Source: NICE Evidence Standards Framework for digital health technologies
Early use, routine use and existing use
Since July 2025 NICE assesses medtech, diagnostics and digital products through its HealthTech programme, with guidance matched to the product's stage
Source: NICE HealthTech programme manual
CCSD coding
CCSD is the standard procedure coding schedule for UK private healthcare, maintained by a group including Bupa, AXA Health, Aviva and Vitality
Source: CCSD
Paul Robinson
14 years in UK private healthcare
I solve this one for healthcare companies
Want a hand? I'll look at your situation and tell you the three things I'd tackle first.
A few quick questions, about two minutes. I read every one myself and usually reply the same day.
No sales call unless you ask for one. Just a straight answer from me.
I reply personally, usually the same day.
Questions
Frequently asked questions
Do private insurers need a health economic model?
Usually they need to know the episode is clinically appropriate, billable and priced sensibly. A clear cost per episode and outcome data matter more than a QALY.
What if the hospital absorbs the cost within a package price?
Then the hospital is your payer. Show how your product protects or improves their margin per package.
When do we need a full cost-effectiveness model?
When you are pursuing NICE HealthTech guidance or large NHS commissioning decisions. Start simpler for private providers.
Whose numbers should we use?
The provider's wherever possible. A model built on their own tariff and costs is far more persuasive than published averages.
How do we handle savings that fall into another budget?
Say so plainly and show the saving that lands in the budget holder's own area first.
Last reviewed:
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