Introduction

The “health benefit basket” in France is to be reformed. The Social Security Act of 18 December 2003 (Loi de Financement de la Sécurité Sociale, LFSS) changed the inpatient acute care funding rules.

Since 1 January 2008, services provided for inpatient or outpatient acute care are financed through a payment-per-case system. This is based on a diagnosis-related group type. A nationally fixed tariff (Groupe Homogène de Séjour, GHS, Homogeneous group of stays) is applied to each GHM (Groupe Homogène de Malades, diagnosis related group).

Health insurance expenditure is required to be efficient, effective and useful with-in the constraints of the financial implementation of GHS. GHS represented 787 GHMs (or DRGs) in the 2007 database (Version 12) and 24 major diagnostic categories (MDC). Medicine, surgery and obstetrics covered 78% of these 787 GHMs. Until now, GHS described only the average length of stay and associated cost by GHM. Since 2004, a rationing budgeting system (Tarification à l'Activité, known as T2A in France) has been set up progressively to allocate financial resources to hospitals according to their activities, just like the Medicare program does in financing hospitals with DRG in USA. At the present stage of development, it covers 35% of hospital budgets in 2006 for the 1,006 public and 1,871 private hospitals (SAE [statistique annuelle des établissements], DREES [Direction de Recherche, des Etudes, de l'Evaluation et des Statistiques], French health ministry), to reach 100% in 2008 for public hospitals.