France

Health systems in transition France 41
PMSI
The PMSI is based on the production of a standard discharge summary (résumé
standardisé de sortie) for each acute hospital stay, which describes the nature of
the treatment and examinations, the diagnosis underlying the hospital admission
and associated diagnoses or complications. The discharge summary is then
integrated into the homogeneous hospital stay groups (groupes homogènes
de séjours; GHS), the French DRG system that was adapted from the DRG
classification system for hospital stays used in the United States.
The PMSI was first introduced in 1983 and became exhaustive after the
1996 reform. Initially limited to the acute care sector (médecine, chirurgie,
obstétrique), it was later extended to HAD, for the rehabilitation sector (soins
de suite et de réadaptation; SSR) and for the psychiatric sector (based on
the summary of medical information for psychiatry (recueil d’informations
médicalisées en psychiatrie). All of these systems retain data from their
implementation date, and a patient’s course may be followed over the years
and across systems.
National cost scales (echelle nationale des coûts à méthodologie commune)
have been established. A national baseline for costs per stay (DRG based) in the
acute care sector has been constructed from a voluntary sample of public and
private hospitals, with a detailed accounting system producing an evaluation
of the total cost of each stay. For each DRG, the median cost of all stays in the
sample is taken as a reference point. Similarly, national cost scales exist for
HAD and SSR. The SSR sector is also supposed to be paid on a DRG basis
system in the near future.
Reimbursement claim systems
Reimbursement claim systems include patient data such as age, gender, place
of residence, affiliation number, eligibility for 100% coverage and reasons for
eligibility (such as CMU or long-term illness (affection de longue durée; ALD))
and data on type and quantity of care consumed.
In the SHI general scheme, the system for extraction, research and analysis
for economic follow-up (extraction, recherches et analyses pour un suivi
medico-économique) collects data on health care consumption. Data are
maintained for the previous two years plus the current running year and older
data are archived.