(The President of the French Republic Emmanuel Macron called for the exit of the “Tarification à la activité (T2A) – Activity-based Pricing”. Introduced in 2004, this method of remuneration is accused of having led hospitals into a race for profitability).
For the French Federation of private hospitals (FHP), funding reforms must be tools that serve a health strategy, and not the opposite.
This is a difficult period, with inflation, a shortage of human resources, a succession of crises (pandemic, seasonal tensions), reform of authorisations, revision of regional planning and, above all, numerous unfinished reforms that make it preferable not to open new projects that are deeply insecure for the players.
The real challenge is to have a financing model that is adapted to the activities of the establishments. Activity-based pricing is the only method of medical funding, based on medical data, which is also enforceable against the parties: hospitals and health insurance.
The debate on reducing its share is mainly fuelled by a public approach to hospitalisation, even though activity only accounts for 53% of the funding of public hospitals, which are largely financed by other envelopes, in particular the so-called MIGACs (missions of general interest and contractual aid), from which private establishments receive very little (1%).
It should be remembered that the advent of activity-based pricing corrected the dysfunctions caused by funding based on operating grants. It originally had several structuring objectives for the resources of public and private health establishments, including a harmonisation of funding mechanisms. The FHP maintains its demand: the same patient, the same care, the same price.
Health insurance must be able to be a wise “payer” ensuring the care of the population in all parts of the country, with the principle that the same pathology requiring the same care by the same professionals is paid for at the same price, whatever the legal status of the structure.
In the same way, the method of financing establishments must take into account the reality of costs and their evolution, so as to offer the clarity necessary for investment. Thus, as the hospital sector is regulated, establishments must be financed at the fair cost of the procedures and care provided. This is an important issue for innovation.
The activety-based financing does not favour (or disadvantage) any particular type of structure. It is only the pricing policy that allows activities to be supported or not!
The attachment to activity-based financing is strong, and any evolution must serve objectives that allow for the recognition and fair payment of activities, the improvement of care and quality, and prevention or missions.
We therefore recommend that the share of quality be developed. Taken out of the tariffs, it must be able to be a stronger incentive than it is. Ma santé 2022 provided for the increase in quality funding to 2 billion euros, including 1 billion euros for the financial incentive for quality improvement system (IFAQ) by 2022. In the end, the context only allowed 700 million euros to be allocated to IFAQ in 2022, and in truth 400 million euros were actually distributed to quality. We also want the issue of relevance to be reinvested. We are also focusing the implementation of new funding on the issues of prevention, support for chronic diseases and for the elderly and dependent persons, in line with the priorities of the national plan Ma santé 2022. We must work on these issues with both the compulsory health insurance and the complementary health insurance organisations.