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Premier bilan de la T2A sur la variabilité des coûts hospitaliers

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  • Carine Milcent

    (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 nationale des ponts et chaussées - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement, PJSE - Paris Jourdan Sciences Economiques - UP1 - Université Paris 1 Panthéon-Sorbonne - 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 nationale des ponts et chaussées - CNRS - Centre National de la Recherche Scientifique)

Abstract

Ce papier étudie la variabilité des coûts hospitaliers pour des séjours comparables en pathologies et en procédures (GHM). A l'époque du budget global, une forte variabilité des coûts était observée entre les hôpitaux publics français. Qu'en est - il aujourd'hui ? Théoriquement, la T2A conduit les établissements à minimiser leurs coûts pour gagner la différence entre le forfait et le coût. Nous montrons une certaine homogénéisation des coûts et à une réelle prise en compte de l'hétérogénéité des individus. Les forfaits par GHM ne capturent cependant pas toute l'hétérogénéité entre les établissements, ni entre les patients. Ainsi, les effets néfastes de sélection des patients ou de diminution du niveau de qualité ne sont pas évités par les forfaits actuels.

Suggested Citation

  • Carine Milcent, 2017. "Premier bilan de la T2A sur la variabilité des coûts hospitaliers," PSE Working Papers halshs-01649554, HAL.
    • Handle: RePEc:hal:psewpa:halshs-01649554
    Note: View the original document on HAL open archive server: https://shs.hal.science/halshs-01649554v1
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    References listed on IDEAS

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    1. Carine Milcent, 2021. "From downcoding to upcoding: DRG based payment in hospitals," International Journal of Health Economics and Management, Springer, vol. 21(1), pages 1-26, March.

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