Health Care Management Science

, Volume 9, Issue 3, pp 295–305 | Cite as

Accounting and reimbursement schemes for inpatient care in France

  • Martine M. Bellanger
  • Laurent Tardif


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.


Cost accounting methodology Tariffs Hospital costs Prospective payment system France 


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  1. 1.
    Bellanger MM, Mossé PR (2005) The search of the holy grail: combining decentralised planning and contracting mechanisms in the French Health Care System. Health Econ 14:119–133CrossRefGoogle Scholar
  2. 2.
    Dormont B, Milcent C (2005) How to regulate heterogenous hopsitals. J Econ Manage Strategy 14(3)Google Scholar
  3. 3.
    Cash R (2005) La tarification à l’activité : première année de mise en œuvre. Rev Econ Financ 76:209–223Google Scholar
  4. 4.
    Or Z (2005) Hospital payment reform in France. Health Policy Monitor 5Google Scholar
  5. 5.
    Michelot X (2005) Hospital Financing in France, introducing case-mix based payment, Communication in ALASS conference, Palma de Majorca, AprilGoogle Scholar
  6. 6.
    Milcent C (2005) Hospital ownership, reimbursement and mortality rates. Health Econ 14(11):1151–1168CrossRefGoogle Scholar
  7. 7.
    Dormont B, Milcent C (2004) The sources of hospital cost variability. Health Econ 13(10):927–939CrossRefGoogle Scholar
  8. 8.
    de Pouvourville G, Comar I, Bouvier V (1994) Le paiement à la pathologie des hôpitaux : l'expérience française. Rev Epidém et Santé Publ 42:79–87Google Scholar
  9. 9.
    Newhouse JP (1996) Reimbursing health plans and health providers: efficiency in production versus selection. Journal of Econ Lit XXXIV:1236–1263Google Scholar
  10. 10.
    Fetter R, Shin, YS, JL et al (1980) Case-mix definition by diagnosis related groups. Med Care 18(2):1–53Google Scholar
  11. 11.
    Le Guen Y (2005) La tarification à l’activité, ppt presentation, AvrilGoogle Scholar
  12. 12.
    Hsiao WC, Braun P, Dunn DD, Becker R (1988) Resource-based relative value scale: an overview. JAMA 16:2347–2443CrossRefGoogle Scholar
  13. 13.
    Cnamts-Pôle Nomenclature Tarification des actes techniques de la CCAM—Coût de la pratique : méthode d’évaluation des surcoûts, (CNAMTS, Paris, 2003)Google Scholar
  14. 14.
    Direction de l’hospitalisation et de l’organisation des soins (DHOS) (2005) circulaire N° DHOS-F-O/DSS-1AGoogle Scholar
  15. 15.
    Ministère de la santé Guide méthodologique de la comptabilité analytique, BO 2004 4 Bis, N° spécialGoogle Scholar
  16. 16.
    Grolier J, Pérard Y, Peyret P (2002) La comptabilité analytique hospitalière médicalisée (Editions ENSP, Rennes)Google Scholar
  17. 17.
    Moisdon JC (1997) Du mode d’existence des outils de gestion Paris (Seli-Arslan, Paris)Google Scholar
  18. 18.
    Cots FF, Elvira D, Casells X, Saez M (2003) Relevance of outliers cases in case mix systems and evaluation of trimming method. Health Care Mang Sci 6(1):27–35CrossRefGoogle Scholar
  19. 19.
    Cots F, Mercade L, Casells X et al (2004) Relationship between hospital structure level and length of stay outliers—implications for hospital payment systems. Health Policy 68(2):159–168CrossRefGoogle Scholar
  20. 20.
    Crow EL, Shimizu K eds. (1988) Log-normal distributions: theory and application. Dekker, New YorkGoogle Scholar
  21. 21.
    Constant E, Garin H, Bouchet C, Kholer F (1998) Differences of case-mix according to the type of hospital: methodological aspects and results. Medinfo 9(Pt 2):8874–8878Google Scholar
  22. 22.
    Agence technique de l’information sur l’hospitalisation (ATIH) (2005) Fiche 1à 11 Construction des tarifsGoogle Scholar
  23. 23.
    Davino M (2004) Are outlier charges likely to raise CMS scrutiny? Healthc Financ Manage 58(2):40–44Google Scholar
  24. 24.
    Shleifer A (1985) A theory of yardstick competition. RAND J Econ 16(3):319–327CrossRefGoogle Scholar
  25. 25.
    Henriet D (2002) Tarification à la pathologie : enjeux et perspectives de l’expérimentation française, Solidarité et Santé, Hors série:21–27Google Scholar
  26. 26.
    Delattre E, Dormont B, McClellan M, Milcent C (2002) Systèmes de tarification et évolutions de la variabilité des coûts hospitaliers en France et aux Etats-Unis, Solidarité et Santé, Hors série:39–52Google Scholar
  27. 27.
    Leleu H, Dervaux B, Bousquet F (2005) Les enjeux d’une mesure de la productivité hospitalière dans le cadre de l’évaluation de la tarification à l’activité, DREES. Dossiers solidarités et santé 3:49–66Google Scholar
  28. 28.
    Inspectorate for health and social activities (IGAS) and the General Inspectorate for finance (IGF), Rapport d’enquête sur le pilotage des dépenses hospitalières, (Juillet 2005).

Copyright information

© Springer Science + Business Media, LLC 2006

Authors and Affiliations

  1. 1.École Nationale de la Santé PubliqueRennesFrance

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