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Characteristics and patterns of elective admissions to for-profit and not-for-profit hospitals in France in 2009 and 2010

Author

Listed:
  • William B. Weeks
  • Marie Jardin
  • Alain Paraponaris

    (ORS PACA, GREQAM - Groupement de Recherche en Économie Quantitative d'Aix-Marseille - EHESS - École des hautes études en sciences sociales - AMU - Aix Marseille Université - ECM - École Centrale de Marseille - CNRS - Centre National de la Recherche Scientifique)

Abstract

In the mid 2000s, in an effort to increase competition among hospitals in France – and thereby reduce hospital care costs – policymakers implemented a prospective payment system and created incentives to promote use of for-profit hospitals. But such policies might incentivize ‘upcoding' to higher-reimbursed procedures or overuse of preference-sensitive elective procedures, either of which would offset anticipated cost savings. To explore either possibility, we examined the relative use and costs of admissions for ten common preference-sensitive elective surgical procedures to French not-for profit and for-profit sector hospitals in 2009 and 2010. For each admission type, we compared sector-specific hospitalization characteristics and mean per-admission reimbursement and sector-specific relative rates of lower- and higher-reimbursed procedures. We found that, despite having substantially fewer beds, for-profit hospitals captured a large portion of market for these procedures; further, for-profit admissions were shorter and less expensive, even after adjustment for patient demographics, hospital characteristics, and patterns of admission to different reimbursement categories. While French for-profit hospitals appear to provide more efficient care, we found coding inconsistencies across for-profit and not-for-profit hospitals that may suggest supplier-induced demand and upcoding in for-profit hospitals. Future work should examine sector-specific changes in relative use and billing practices of for elective surgeries, the degree to which these elective surgeries are justified in either sector, and whether outcomes differ according to sector used.

Suggested Citation

  • William B. Weeks & Marie Jardin & Alain Paraponaris, 2015. "Characteristics and patterns of elective admissions to for-profit and not-for-profit hospitals in France in 2009 and 2010," Post-Print hal-01456102, HAL.
  • Handle: RePEc:hal:journl:hal-01456102
    DOI: 10.1016/j.socscimed.2015.03.051
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    References listed on IDEAS

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    1. Carine Milcent & Julie Rochut, 2009. "Tarification hospitalière et pratique médicale. La pratique de la césarienne en France," Revue économique, Presses de Sciences-Po, vol. 60(2), pages 489-506.
    2. William B. Weeks & Marie Jardin & Jean-Charles Dufour & Alain Paraponaris & Bruno Ventelou, 2014. "Geographic variation in admissions for knee replacement, hip replacement, and hip fracture in France: evidence of supplier-induced demand in for-profit and not-for-profit hospitals," Post-Print hal-01463910, HAL.
    3. Leemore S. Dafny, 2005. "Games Hospitals Play: Entry Deterrence in Hospital Procedure Markets," Journal of Economics & Management Strategy, Wiley Blackwell, vol. 14(3), pages 513-542, September.
    4. Gaynor, Martin & Vogt, William B, 2003. "Competition among Hospitals," RAND Journal of Economics, The RAND Corporation, vol. 34(4), pages 764-785, Winter.
    5. A. M. Spence, 1981. "The Learning Curve and Competition," Bell Journal of Economics, The RAND Corporation, vol. 12(1), pages 49-70, Spring.
    6. Capps, Cory & Dranove, David & Satterthwaite, Mark, 2003. "Competition and Market Power in Option Demand Markets," RAND Journal of Economics, The RAND Corporation, vol. 34(4), pages 737-763, Winter.
    7. Jonathan S. Skinner & Elliott S. Fisher & John Wennberg, 2005. "The Efficiency of Medicare," NBER Chapters, in: Analyses in the Economics of Aging, pages 129-160, National Bureau of Economic Research, Inc.
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    Cited by:

    1. Emmanuel Kemel & Antoine Nebout & Bruno Ventelou, 2021. "To test or not to test? Risk attitudes and prescribing by French GPs," Working Papers hal-03330153, HAL.

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