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in collaboration with
Dr Gérald Kierzek (Medical Director of Doctissimo)
Medical validation:
February 03, 2023
Introduced in 2004, activity-based pricing is the only financing method for French health establishments, public and private. But it has the effect of pushing the hospital towards a logic of profitability.
Many of them denounce “the inflationary spiral” which weighs on the French hospital. And for good reason: activity-based pricing, better known as T2A, consists of remunerating healthcare establishments according to the number of procedures performed. But this method of financing could push doctors and caregivers to perform only the most lucrative acts.
Towards a logic of “profitability”
Earlier this year, the government announced the end of hospital fee-for-service (T2A)”from the next Social Security budget“.
This mode of financing, which encourages the hospital to seek the best productivity, has in fact come under a certain number of criticisms in recent years.
“These tariffs encourage us to ask ourselves which acts will be the most lucrative“, specifies Anne Gervais, doctor, specialized in hepatology at the Bichat hospital in Paris.
A perverse effect, which has not even been proven on the budget side: hospitals have never been so indebted.
Faced with this delicate subject, François Braun wishes to be transparent.
“We’re not going to solve everything in a snap. We are not going back to the system before, the overall envelope had terrible drifts. We see the problem with this unit pricing, it’s a race to the shallot in the act. We want to put the response to the health needs of the French people back at the center of the debate and funding“.
Towards a new way of financing hospitals?
If the T2A has favored the productivity and profitability of activities, it is clear that this model does not work.
“It is a pricing that is based on the volume, but not on the quality, nor on the relevance of the acts. This pushes caregivers to perform more and more care. The other perverse phenomenon is the annual envelope devoted to hospitals, in which we draw but which does not increase“, regrets Dr. Kierzek.
So what solution should you consider? “There should be mixed funding, which is partly indexed to volume – if caregivers work more, they should be paid more. This system must also smooth out the inequalities between the public and the private sector. To do this, it is necessary to index the remuneration and update the rating of the axes“, concludes the expert.