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Coût des soins hospitaliers : effet de la concurrence par la qualité

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  • Carine Milcent

    (CEPREMAP - Centre pour la recherche économique et ses applications - ECO ENS-PSL - Département d'économie de l'ENS-PSL - ENS-PSL - École normale supérieure - Paris - PSL - Université Paris Sciences et Lettres, PSE - Paris-Jourdan Sciences Economiques - ENS-PSL - École normale supérieure - Paris - PSL - Université Paris Sciences et Lettres - INRA - Institut National de la Recherche Agronomique - EHESS - École des hautes études en sciences sociales - ENPC - École des Ponts ParisTech - CNRS - Centre National de la Recherche Scientifique, PSE - Paris School of Economics - UP1 - Université Paris 1 Panthéon-Sorbonne - ENS-PSL - École normale supérieure - Paris - PSL - Université Paris Sciences et Lettres - EHESS - École des hautes études en sciences sociales - ENPC - École des Ponts ParisTech - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement)

Abstract

Ce papier vise à étudier l'hétérogénéité des coûts hospitaliers pour des séjours comparables en pathologie et en procédures (Groupe homogène de séjours _GHS). A l'époque du budget global, une forte hétérogénéité des coûts était observée entre les hôpitaux publics français. Qu'en est-il aujourd'hui ? La tarification à l'activité (T2A) mise en place entre 2004 et 2008, a introduit la concurrence des établissements hospitaliers français qu'ils soient publics, privés, à but non lucratif ou à but lucratif. Avec la T2A, les établissements sont désormais payés au forfait par séjour. Théoriquement, un mode de tarification par forfait devrait conduire les établissements à minimiser leur coût afin de gagner la différence entre le forfait et le coût. La mise en concurrence des établissements devrait accélérer ce mécanisme de minimisation des coûts. Nous montrons que malgré de grands changements dans les modes de régulation, les forfaits par GHM ne capturent pas toute l'hétérogénéité entre les établissements ni l'ensemble du case-mix des patients.

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  • Carine Milcent, 2014. "Coût des soins hospitaliers : effet de la concurrence par la qualité," Working Papers halshs-01010327, HAL.
    • Handle: RePEc:hal:wpaper:halshs-01010327
    Note: View the original document on HAL open archive server: https://shs.hal.science/halshs-01010327
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    References listed on IDEAS

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    1. Carine Milcent, 2016. "Upcoding and heterogeneity in hospitals’ response: A Natural Experiment," PSE Working Papers halshs-01340557, HAL.

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