Life at a premium: considering an end-of-life premium in Value Based Reimbursement.

The increasingly explicit use of health technology assessment continues to generate substantial public and academic policy debates. The debates are about puzzling issues whose correct resolution is not immediately obvious and the very explicitness of HTA’s use pinpoints the issues and locates those likely to gain or lose from the solutions. The application of an end-of-life premium is one of a number of proposed ‘values’ for affecting who wins and who loses from HTA and reimbursement processes. In this chapter we review the literature on value premiums generally and the end of life premium specifically, before describing a conceptual framework for coherent use of value premiums in reimbursement decision process and how an end-of-life premium might work.