Reform of financing of public hospitals: what was the impact on their level of activity?

The adoption of per-activity pricing (T2A) modified the method of financing the hospital sector. The lawmaker's goal was to increase efficiency and improve quality of care. In public or private not-for-profit establishments, a refund per hospital stay gradually replaced the overall annual grant between 2004 and 2008. In private for-profit establishments, the reimbursement amount for a hospital stay was subject to local variations until 2005; after 2005, a national fee schedule determined these amounts according to a hospital stay classification. According to data from the Programme for the medicalisation of information systems (PMSI), this price reform has resulted in a gradual increase in surgical activity in the public sector. Between 2005 and 2008, the average number of hospital stays increased by 2.5 per institution and type of stay, an increase of 9.3% in not-for-profit establishments compared to private for-profit establishments. This increase in activity is more significant in establishments exposed to sharp competition from private clinics, measured by the number of beds in surrounding private establishments, counterbalanced by their distance to each public establishment in question. While the increase in activity is only 3.8% in the one-quarter of public establishments which are less subject to competition from private establishments, it reached 10.3% in the one-quarter of establishments which are subject to the most intense competition from the private sector. The introduction of the T2A has helped improve the attractiveness of public establishments, at least in terms of surgery, a field in which this type of assessment can be conducted in a thorough manner.