IDEAS home Printed from https://ideas.repec.org/a/prs/ecstat/estat_0336-1454_2015_num_475_1_10527.html
   My bibliography  Save this article

Tarification à l'activité et réadmission

Author

Listed:
  • Engin Yilmaz
  • Albert Vuagnat

Abstract

[fre] De nombreux pays de l’OCDE ont introduit des systèmes de paiement à l’activité pour financer leurs établissements de santé. La France a ainsi adopté en 2004 la réforme dite de «tarification à l’activité » (T2A) afin d’inciter ces établissements à davantage d’efficience. La mise en place de cette réforme a surtout intégré jusqu’ici l’impératif économique comme première préoccupation. Toutefois, pour le régulateur, il est important de suivre les effets de cette réforme sous l’angle de la qualité des soins. Une mesure de la qualité des prises en charge peut être appréhendée par le taux de réadmission à trente jours. L’objet de cette étude est de s’intéresser à la réadmission à la fois sur la période qui précède la T2A et sur la période faisant suite à sa mise en place. La période d’étude s’étend de 2002 à 2012. À partir des données du Programme médicalisé du système d’informations (PMSI), pour chaque séjour chirurgical, la réadmission à trente jours après la sortie est déterminée au moyen du chaînage PMSI, sous réserve que ces réadmissions ne soient ni des séances de traitements ni de la néonatalogie. La probabilité de réadmission est modélisée à l’aide d’une régression logistique multiple comprenant les cofacteurs suivants : année, âge, sexe, mode d’entrée, durée de séjour, morbidité, statut juridique de l’établissement ainsi que des termes d’interactions. Les résultats mettent en avant une augmentation du risque de réadmission observé au niveau global, mais qui s’explique par une modification de la structure de la population (vieillissement) ainsi que par les modifications de prise en charge. Cette hausse des réadmissions ne s’explique pas par la mise en place de la T2A.

Suggested Citation

  • Engin Yilmaz & Albert Vuagnat, 2015. "Tarification à l'activité et réadmission," Économie et Statistique, Programme National Persée, vol. 475(1), pages 71-87.
  • Handle: RePEc:prs:ecstat:estat_0336-1454_2015_num_475_1_10527
    DOI: 10.3406/estat.2015.10527
    Note: DOI:10.3406/estat.2015.10527
    as

    Download full text from publisher

    File URL: https://doi.org/10.3406/estat.2015.10527
    Download Restriction: no

    File URL: https://www.persee.fr/doc/estat_0336-1454_2015_num_475_1_10527
    Download Restriction: no

    File URL: https://libkey.io/10.3406/estat.2015.10527?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Philippe Choné & Franck Evain & Lionel Wilner & Engin Yilmaz, 2013. "Introducing Activity-Based Payment in the Hospital Industry: Evidence from French Data," CESifo Working Paper Series 4304, CESifo.
    2. Cutler, David M, 1995. "The Incidence of Adverse Medical Outcomes under Prospective Payment," Econometrica, Econometric Society, vol. 63(1), pages 29-50, January.
    3. Guccio, Calogero & Lisi, Domenico & Pignataro, Giacomo, 2014. "Readmission and Hospital Quality under Prospective Payment System," MPRA Paper 56490, University Library of Munich, Germany.
    4. Bardey, David & Canta, Chiara & Lozachmeur, Jean-Marie, 2012. "The regulation of health care providers’ payments when horizontal and vertical differentiation matter," Journal of Health Economics, Elsevier, vol. 31(5), pages 691-704.
    5. Zeynep Or & Unto Häkkinen, 2012. "Qualité des soins et T2A : pour le meilleur ou pour le pire ?," Working Papers DT53, IRDES institut for research and information in health economics, revised Dec 2012.
    6. Andrei Shleifer, 1985. "A Theory of Yardstick Competition," RAND Journal of Economics, The RAND Corporation, vol. 16(3), pages 319-327, Autumn.
    7. Davis, Carolyne K. & Rhodes, Deborah J., 1988. "The impact of DRGs on the cost and quality of health care in the United States," Health Policy, Elsevier, vol. 9(2), pages 117-131, April.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Choné, Philippe, 2017. "Competition policy for health care provision in France," Health Policy, Elsevier, vol. 121(2), pages 111-118.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Li‐Lin Liang, 2015. "Do Diagnosis‐Related Group‐Based Payments Incentivise Hospitals to Adjust Output Mix?," Health Economics, John Wiley & Sons, Ltd., vol. 24(4), pages 454-469, April.
    2. Parida Wubulihasimu & Werner Brouwer & Pieter van Baal, 2016. "The Impact of Hospital Payment Schemes on Healthcare and Mortality: Evidence from Hospital Payment Reforms in OECD Countries," Health Economics, John Wiley & Sons, Ltd., vol. 25(8), pages 1005-1019, August.
    3. Hamada, Hironori & Sekimoto, Miho & Imanaka, Yuichi, 2012. "Effects of the per diem prospective payment system with DRG-like grouping system (DPC/PDPS) on resource usage and healthcare quality in Japan," Health Policy, Elsevier, vol. 107(2), pages 194-201.
    4. Matthias Bäuml & Christian Kümpel, 2021. "Hospital responses to the refinement of reimbursements by treatment intensity in DRG systems," Health Economics, John Wiley & Sons, Ltd., vol. 30(3), pages 585-602, March.
    5. Hanjo M. Koehler, 2006. "Yardstick Competition when Quality is Endogenous: The Case of Hospital Regulation," Working Papers 013, Bavarian Graduate Program in Economics (BGPE).
    6. Rozalia Nistor & Costel Nistor & Mihaela-Carmen Muntean & Ludmila Daniela Manea, 2013. "Information And Communication Technology In Health Services In Romania," Risk in Contemporary Economy, "Dunarea de Jos" University of Galati, Faculty of Economics and Business Administration, pages 106-114.
    7. Bisceglia, Michele & Cellini, Roberto & Siciliani, Luigi & Straume, Odd Rune, 2020. "Optimal dynamic volume-based price regulation," International Journal of Industrial Organization, Elsevier, vol. 73(C).
    8. Kathleen Carey, 2015. "Measuring the Hospital Length of Stay/Readmission Cost Trade‐Off Under a Bundled Payment Mechanism," Health Economics, John Wiley & Sons, Ltd., vol. 24(7), pages 790-802, July.
    9. Guccio, Calogero & Lisi, Domenico & Pignataro, Giacomo, 2014. "Readmission and Hospital Quality under Prospective Payment System," MPRA Paper 56490, University Library of Munich, Germany.
    10. Simon Reif & Lucas Hafner & Michael Seebauer, 2020. "Physician Behavior under Prospective Payment Schemes—Evidence from Artefactual Field and Lab Experiments," IJERPH, MDPI, vol. 17(15), pages 1-37, July.
    11. Bäuml, Matthias & Kümpel, Christian, 2020. "Hospital responses to the introduction of reimbursements by treatment intensity in a (presumably lump sum) DRG system," hche Research Papers 22, University of Hamburg, Hamburg Center for Health Economics (hche).
    12. Mak, Henry Y., 2018. "Managing imperfect competition by pay for performance and reference pricing," Journal of Health Economics, Elsevier, vol. 57(C), pages 131-146.
    13. Marc Nikitin & Jean-Baptiste Capgras & Dragos Zelinschi, 2017. "Dynamiques de la gouvernementalité : concurrence et calcul des coûts dans le système de santé français," Post-Print hal-01907396, HAL.
    14. Moreno-Serra, Rodrigo & Wagstaff, Adam, 2010. "System-wide impacts of hospital payment reforms: Evidence from Central and Eastern Europe and Central Asia," Journal of Health Economics, Elsevier, vol. 29(4), pages 585-602, July.
    15. Galina Besstremyannaya, 2013. "Heterogeneous hospital response to a per diem prospective payment system," Working Papers w0193, New Economic School (NES).
    16. Christoph Schwierz & Boris Augurzky & Axel Focke & Jürgen Wasem, 2012. "Demand, selection and patient outcomes in German acute care hospitals," Health Economics, John Wiley & Sons, Ltd., vol. 21(3), pages 209-221, March.
    17. Bogetoft, Peter & Nielsen, Kurt, 2003. "Yardstick Based Procurement Design In Natural Resource Management," 2003 Annual Meeting, August 16-22, 2003, Durban, South Africa 25910, International Association of Agricultural Economists.
    18. Rossi, Martín, 2000. "Análisis de eficiencia aplicado a la regulación ¿Es importante la Distribución Elegida para el Término de Ineficiencia?," UADE Textos de Discusión 22_2000, Instituto de Economía, Universidad Argentina de la Empresa.
    19. Daron Acemoglu & Amy Finkelstein, 2008. "Input and Technology Choices in Regulated Industries: Evidence from the Health Care Sector," Journal of Political Economy, University of Chicago Press, vol. 116(5), pages 837-880, October.
    20. Gijs Roelofs & Daniel Vuuren, 2017. "The Decentralization of Social Assistance and the Rise of Disability Insurance Enrolment," De Economist, Springer, vol. 165(1), pages 1-21, March.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:prs:ecstat:estat_0336-1454_2015_num_475_1_10527. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Equipe PERSEE (email available below). General contact details of provider: https://www.persee.fr/collection/estat .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.