Accounting and reimbursement schemes for inpatient care in France

Abstract

The new French case-mix system of hospital payment was adopted in 2004 for public hospitals and in March 2005 for private-for-profit hospitals. Implementing this reform requires a period of transition but the challenges ahead can already be predicted. Prices will have to change before this mode of reimbursement can have any real impact. This requires producing more detailed hospital cost data and using fine measuring tools such as the cost accounting method developed for use in this context. This article describes and analyses the main tools and methods selected to implement the new French prospective payment system.

Paying for hospital care: the experience with implementing activity-based funding in five European countries

“…Moreover, private-for-profit hospitals, which provide more than half of all surgery in France, were paid by a mixture of per diem and fee-for-service. The introduction of a payment scheme based on activity was seen as a way of Bellanger and Tardif (2006), Epstein and Mason (2006), Ettelt et al (2006), Miraldo et al (2006) and Ettelt and Nolte (2010).…”

“…b Covered through activity-based funding and separate grants. c A small proportion of costs are determined at patient level (Bellanger and Tardif, 2006). data, a top-down approach, as currently implemented in England, France and Ireland, involves the allocation of relevant hospital expenditure to particular services or specialties .…”

Methods to determine reimbursement rates for diagnosis related groups (DRG): A comparison of nine European countries

“…As a consequence of having had some difficulties regarding the quality of data delivered, the data collection authorities in some countries provide special monetary incentives to hospitals that comply with predefined standards for product-costing. For example, in France, half of the yearly salary for an accountant is paid to each of the 52 hospitals participating in the data sample [4]. After having calculated DRG cost weights without using monetary incentives for participating hospitals in the years 2003 and 2004, Germany introduced such payments in 2005.…”

Zasady rachunku kosztów francuskich szpitali na potrzeby wyceny świadczeń zdrowotnych

“…względny wskaźnik kosztów (relative cost index -ICR). Wskaźnik ten jest ustalany w punktach i stanowi sumę trzech komponentów, które dotyczą różnych zasobów wykorzystywanych przy wykonywaniu procedur [Bellanger, Tardif 2006]:…”

“…W skład kosztów całego procesu leczenia pacjenta wchodzą trzy główne elementy [Bellanger, Tardif 2006]: 1. koszty medyczne; skiej dokładności w przypisywaniu pacjentom nawet najmniejszych ilości leków, także leków nieistotnych kosztowo; • metoda wyodrębniania drogich produktów -na konkretnych pacjentów wyodrębniane są jedynie leki i inne produkty istotne dla procesu leczenia według kryterium kosztowego. Koszt pozostałych produktów ustala się jako średnią dla każdego pacjenta, przeliczając ich wartość na jeden osobodzień pobytu w oddziale.…”