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Background The current increase in risk-sharing agreements is mainly due to two factors: the specifics of the health market and the shift in the balance of power between producers and payers. The health market is unique because you cannot buy, sell or negotiate health care. When payers decide to buy drugs, they actually buy a probability of achieving health for each patient population. However, medicines are allowed, imported and reimbursed under uncertain conditions. This uncertainty can bring many unique dimensions: in terms of the administrative efforts required to manage these contracts when applied to personalized medicine, respondents felt that they were as high in price-volume agreements as in the case of conventional medicine; However, for other types of contracts, this burden should be higher. Toumi M. ZardJ, Duvillard R, Jonmi C. Innovative drugs and market access agreements. Pharmaceutical records. 2013;71(5):302–25.

In Spain, empirical studies on risk-sharing agreements are rare. We found only one publication [35] assessing the results of the risk-sharing contract for geitinib in Catalonia; other studies conducted by Rojas and Antonanzas [36] have focused on the perception by several interested parties in Spain of the adequacy of these contracts as a management instrument. They conducted in-depth interviews with 14 medical specialists (hospital pharmacists, laboratory directors and oncologists) to understand the legal and practical aspects of different types of agreements and the prospects for their future use. This study found that most of the contracts were signed at the local level between hospitals and pharmaceutical companies. The hospital pharmacists are committed to managing these contracts; Given the limitations of the sample size of this empirical work, further research is needed to better understand their pros and cons and to confirm some of the results obtained so far in the literature. Under a traditional service-based pricing model, physicians and other health care providers are reimbursed by the total number of services they provide. However, in a value-based payment program, providers are held liable for care costs. Providers are offered a one-time payment per patient and must provide effective care or risk losing money within this budget. The financial sustainability of health systems is a major concern, given the rising health costs induced by new technologies and the increase in demand for health services, mainly due to the ageing of the population in Western societies.