France

94
Health systems in transition
France
Payment of hospitals
All hospitals, except for long-term care and psychiatry, are funded using T2A,
based on GHSs. Using data from the PMSI, each patient stay is classified in one
of the approximately 2200 DRGs, and an associated GHS. Each GHS is subject
to a lump-sum tariff that is set annually. GHS tariffs are calculated differently
for public and private hospitals and do not include the same services (see below).
Within the T2A, there are two primary categories of hospital reimbursement:
medical activity-based payment and non “activity”-based payment.
The medical activity-based category covers three areas:
• GHS tariffs per hospital stay, which have no cost weights other than regional
weights to account for regional level variations in production costs;
• additional fees for outpatient consultations, emergency ward visits and all
hospital activities other than inpatient care; and
• additional payments for expensive technologies and interventions include
a defined list of expensive drugs and medical devices and intensive care
activities; to avoid discouraging the use of expensive and innovative medical
technologies, these are first allocated an additional payment and then over
time integrated into the GHS tariffs.
Block grants and non “activity”-based financing cover three main areas:
• block grants provide annual lump sum funding, such as for emergency care,
organ retrieval and transplants;
• public utility missions, also referred to as missions for general interest and
contracting (missions d’intérêt général et d’aide à la contractualisation),
serve to fund coordination of care, plus epidemiological surveillance and
expertise; two separate lump sums are defined by the regional health
agencies on a contractual basis: one for education, research-related activities
and innovation in teaching hospitals (missions d’enseignement, de recherche,
de référence et d’innovation); and the other for activities to meet national or
regional priorities or specific public missions; and
• innovative medical technologies and procedures, especially those awaiting
registration on a positive list, are financed through two research programmes:
the hospital clinical research programme (programme hospitalier de
recherche clinique), the main source of public funding for clinical research
projects assessing the effectiveness of the new treatment strategy; and the
programme supporting funds for economic evaluation (Programme de
recherche medico-économique), assessing the efficiency of the innovation.