International healthcare and reimbursement systems underwent a radical transformation in the 2000s, resulting from growing financial pressures incited by economic depression and a steady rise in healthcare spending. This phenomenon was most pronounced in the United States, where the health-spending share of GDP rose from five percent in 1960 to 17.9 percent in 2011. In Organization for Economic Co-operation and Development (OECD) countries on average, healthcare spending as a percentage of GDP grew from four percent to 9.6 percent over the same period. Although specifics varied by country, the systemic evolution of international healthcare and reimbursement standards was characterized by two main trends–a shift toward value-based pricing; and more stringent reimbursement standards for new drug evaluations. With this in mind, each country developed its own methods and decision-making processes for reimbursing companies looking to penetrate its market with new innovations. The United Kingdom, Germany, and Japan exemplified this dynamic.
