Since 2004, French public and private hospitals are submitted to a prospective per-case based payment system based on a drg like classification scheme. A comparative analysis with the Medicare prospective payment scheme shows that the implementation of the so-called Activity Based Payment Scheme (T2A) is embedded in a national expenditure cap and planning regulations which restrict the strategic autonomy of providers. Moreover, the system blends retrospective and prospective elements which limit the incentive to reduce unit costs. Altogether, the French model is closer to regulation with fixed rates under planning constraints than to the initial “yardstick competition model” that was implemented by Medicare in the usa. The consequences of the French model on resource allocation are then discussed using a selection of theoretical and empirical contributions on the incentive effects of prospective per case payment.
PUYOU DE POUVOURVILLE, G. (2009). Les hôpitaux français face au paiement prospectif au cas. La mise en œuvre de la tarification à l’activité. Revue Economique, 60(2), pp. 457-470.