Treść książki

Przejdź do opcji czytnikaPrzejdź do nawigacjiPrzejdź do informacjiPrzejdź do stopki
1.1.NEWCHANGESINPUBLICHOSPITAL
FUNDING:THEFRENCHDRGs(GHS)AND
THEIRCONSEQUENCESONLOW-INCOME
PATIENTSANDSOCIALDISABILITIES
1.1.1.INTRODUCTION
The"healthbenefitbasket”inFranceistobereformed.TheSocialSecurityActof
18December2003(LoideFinancementdelaSécuritéSociale,LFSS)changedthe
inpatientacutecarefundingrules.1
Since1January2008,servicesprovidedforinpatientoroutpatientacutecareare
nancedthroughapayment-per-casesystem.Thisisbasedonadiagnosis-related
grouptype.Anationallyxedtariff(GroupeHomogènedeSéjour,GHS,Homo-
geneousgroupofstays)isappliedtoeachGHM(GroupeHomogènedeMalades,
diagnosisrelatedgroup).
Healthinsuranceexpenditureisrequiredtobeefficient,effectiveandusefulwith-
intheconstraintsofthenancialimplementationofGHS.2GHSrepresented787
GHMs(orDRGs)inthe2007database(Version12)and24majordiagnosticcatego-
ries(MDC).Medicine,surgeryandobstetricscovered78%ofthese787GHMs.Until
now,GHSdescribedonlytheaveragelengthofstayandassociatedcostbyGHM.
Since2004,arationingbudgetingsystem(Tarificationàl,Activité,knownasT2Ain
France)hasbeensetupprogressivelytoallocatenancialresourcestohospitalsac-
cordingtotheiractivities,justliketheMedicareprogramdoesinnancinghospitals
withDRGinUSA.Atthepresentstageofdevelopment,itcovers35%ofhospi-
talbudgetsin2006forthe1,006publicand1,871privatehospitals(SAE[statis-
tiqueannuelledesétablissements],DREES[DirectiondeRecherche,desEtudes,de
l,EvaluationetdesStatistiques],Frenchhealthministry),toreach100%in2008for
1M.M.Bellanger,V
.Cherilova,V
.Paris(2005),The"HealthBenefitBasket”inFrance,Euro-
peanJournalHealthEconomics[suppl.1]6,p.24–29.
2C.Segouin,P.H.Bréchat,L.Lebrun,F.Sahraoui(2006),LesrévolutionsduPMSIetdela
T2A:Bilansetperspectives[in:]P.H.Bréchat,E.Salines,C.Segouin(dir.),Médecinsdesanté
publique,ÉditionsENSP,Rennes,p.212–223.