Health Financing

The design of contribution mechanisms, risk pooling arrangements, and provider payment models has direct consequences for system sustainability, equity, and the behaviour of every actor within the system. What works in one market does not automatically transfer to another.

Zeumed advises governments and payers on the full range of health financing decisions — from system design and multi-insurer transitions to payment reform and value-based approaches.

WHAT WE DO

Health Financing Services

Multi-insurer transitions & risk pooling

Supporting transitions from single-budget or single-payer models to multi-insurer or hybrid arrangements — including risk pooling design, benefit responsibilities, and purchasing roles to prevent fragmentation, risk selection, or cost shifting.

Payment models & incentive design

Designing provider payment models that align incentives with system objectives — including activity-based, bundled, population-based, and hybrid approaches — with econometric analysis of how payment changes affect utilisation and provider behaviour.

Financial protection & out-of-pocket spending

Redesigning benefit packages and cost-sharing structures to reduce financial hardship and unmet need, while maintaining fiscal control and predictable expenditure growth.

Value-based healthcare & procurement

Designing payment frameworks and procurement approaches that reward outcomes rather than volume — including staged implementation, clinician-level incentive modelling, and value-based procurement design for products and services.

Financing high-cost & complex patient groups

Designing funding approaches for patient groups that account for a disproportionate share of spending, including using microcosting models.

IN FOCUS

Value-Based Healthcare & Procurement

Moving from volume to value requires payment mechanisms that genuinely change clinical behaviour — not just institutional behaviour. Zeumed designs and models payment frameworks that identify the right decision-maker, anticipate unintended consequences such as cream skimming and risk selection, and introduce incentives in a staged and fiscally controlled way. This work includes modelling elasticity of response at the clinician level, designing outcome-linked top-ups alongside stable base payments, and building the economic models required to articulate and assess value in procurement decisions.

CONNECTED WORK

Low Value Care

Identifying and addressing low value care — interventions that generate cost without commensurate benefit — is the other side of the value-based healthcare challenge. Zeumed has developed a dedicated methodology and analytical framework for low value care identification and payment reform.

OUR WORK

Selected Engagements

VBHC · PAYMENT REFORM · REPRODUCTIVE MEDICINE

Incentive design for clinical outcome improvement in reproductive medicine

A health system sought to improve clinical outcomes in reproductive medicine through payment reform. Earlier attempts to incentivise hospitals had not produced the expected change in clinical behaviour. Zeumed modelled elasticity of response at the clinician level, identifying that the effective decision-maker was the clinician rather than the institution. We designed a payment framework incorporating a stable base payment with outcome-linked top-ups, with specific provisions to prevent cream skimming and risk selection. The approach was also applied to reducing avoidable surgical intervention rates, with incentive structures designed to work at both hospital and clinician level.

HEALTH INSURANCE· SYSTEM DESIGN

Risk equalisation design for a national health insurance system

Zeumed advised on the design of risk equalisation mechanisms for a national health insurance model — ensuring that risk is pooled fairly across insurers, reducing incentives for risk selection, and maintaining system sustainability across population groups with different healthcare needs.

VALUE BASED CARE · PAYMENT DESIGN

Value-based payment framework for innovative treatments

Zeumed designed a value-based payment framework for a category of high-cost innovative treatments, translating value-based care objectives into operational payment structures. The framework incorporated staged implementation, outcome-linked adjustments, and budget impact controls to manage fiscal risk while shifting care delivery incentives over time.

Get in Touch

We welcome enquiries from innovators and payers working on health financing design, payment reform and value based approaches.