To what extent have tariff incentives and the prior approval procedure contributed to the development of day-care surgery?

In order to foster day-care surgery (hospitalization without overnight stay), the French Ministry of Health introduced in 2009 a single tariff for the stays of some pathologies regardless of the mode of care (they are a day-care stays or overnight and non-severe stays). This price incentive to carry out day-care surgery was gradually extended, and generalized from 2014 on. However, its impact on the change in hospital practices remains to be assessed, especially since, at the same time, the Health Insurance implemented a prior approval procedure (MSAP) for a growing number of surgical procedures in the event of full hospitalization. We take advantage of the progressive implementation of these two policies to assess their impact on the day-care rate of the first targeted pathologies, in comparison with other pathologies. In the presence of a possible selection bias, we construct for each targeted pathology a "synthetic control" from non-targeted pathologies. It aims at reproducing both perspectives of day-care rate in the medium term – as assessed by medical learned societies – and day-care rates comparable to those of the targeted pathology before the implementation of the two measures. For many of the targeted pathologies, public hospitals have increased the practice of day-care surgery in response to the single tariff incentive policy or MSAP's constraining policy conducted from 2008/2009 onwards. This increase does not generally seem to have been accompanied by an increase in readmissions or an increase in the total number of stays. These effects are less frequently observed in the private sector, and are almost no longer observed in the 2012 extension of either of the two policies.