The search for the Holy Grail: combining decentralised planning and contracting mechanisms in the French health care system

Bellanger, Martine; Mossé, Philippe

doi:10.1002/hec.1031

Cited by 38 publications

(20 citation statements)

References 16 publications

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“…Since 1998 these budgets also depended on hospital costs as well as on an adjustment based on the regional case-mix [1]. However, this method of calculation was not consistently applied by all Regional Hospital Agencies (ARH).…”

Section: Introductionmentioning

confidence: 99%

“…This statutory system has covered the whole population since the Universal Coverage Act (CMU) of 1st January 2000. Three-quarters of the resources allocated each year to running the health system come from statutory health insurance funds and the remainder comes from individual users, either in the form of direct payments to the providers or indirectly via the contributions paid to the mutual associations or private insurers for complementary health insurance coverage [1].…”

Section: Introductionmentioning

confidence: 99%

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Accounting and reimbursement schemes for inpatient care in France

Bellanger¹,

Tardif²

2006

Health Care Manage Sci

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The new French case-mix system of hospital payment was adopted in 2004 for public hospitals and in March 2005 for private-for-profit hospitals. Implementing this reform requires a period of transition but the challenges ahead can already be predicted. Prices will have to change before this mode of reimbursement can have any real impact. This requires producing more detailed hospital cost data and using fine measuring tools such as the cost accounting method developed for use in this context. This article describes and analyses the main tools and methods selected to implement the new French prospective payment system.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Accounting and reimbursement schemes for inpatient care in France

Bellanger¹,

Tardif²

2006

Health Care Manage Sci

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“…The Juppé plan centralized (public and private) hospital management and other elements of the system, thus turning away from the core principles of mandated systems (Sandier et al 2004). As a result, many new policy elements could be implemented: in 1999, 26 hospitalization regional agencies (ARH) were created in order to organize public and private hospitals, and to manage the allocation of public financing according to local needs and negotiation processes (Bellanger and Mossé 2005). Following this, the French government tabled the Social Security Funding Act, whose objective was to establish a cap on health expenditures controlled by the state and to enforce national priorities in terms of health care goals, a true novelty at that time.…”

Section: Welfare-oriented/mandated Systems: Francementioning

confidence: 99%

Roemer 20 Years Later: When a Classical Health-System Typology Meets Market-Oriented Reforms

Bourque¹,

Farrah²

2017

gouvernance

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In 1990, Roemer came up with a very influential health system typology. From his vast study, emerged three types of health care systems: nationalized, mandated and entrepreneurial. Health care systems are not static; slow changes and reforms somewhat alter values and goals on which those systems were initially established. It is fair to say, then, that over the last two decades, health care reformers have adopted a market-oriented governance model that blends new public management (NPM) and managed competition reforms in the provision of health care services to transform supply- and demand-side actors into “responsibilized” customers, payers or providers. These transformations beg the question as to whether we are witnessing a radical redefinition of health care systems through the implementation of market-oriented governance. We propose to add the evolution of market-oriented health reforms in five case studies to Milton Roemer’s typology of health systems. In light of our findings, we will wrap up the analysis with an assessment of the usefulness of Roemer’s classification for social scientists to grasp the evolution of health systems over the past 20 years, and more importantly, to analyze the current state of these health care systems after years of market-oriented reforms.En 1990 Milton J. Roemer a proposé une typologie des systèmes de santé qui eut une influence importante. Cette grille d’analyse propose d’étudier les systèmes de santé à partir de trois grands modèles : les systèmes nationalisés, mandatés et entrepreneuriaux. Ceux-ci sont toutefois en constante évolution. Des changements incrémentaux ainsi que des réformes plus importantes influencent les valeurs et les objectifs qui les avaient inspirés lors de leur mise en oeuvre. Ainsi, depuis deux décennies on peut affirmer que les systèmes de santé ont emprunté les valeurs associées à la nouvelle gestion publique ainsi qu’à la gouvernance de marché dans le but de responsabiliser les consommateurs et les producteurs de soins. Ces transformations importantes posent la question de la redéfinition des systèmes de santé. Autrement-dit, sommes-nous témoins de changements radicaux des soins de santé nationaux qui nécessitent une nouvelle grille d’analyse ? Cet article propose une analyse des dernières réformes des systèmes de santé de cinq pays à la lumière de la typologie de Roemer tout en prenant en compte les éléments liés à l’implantation de la nouvelle gestion publique et de la gouvernance de marché qui ont influencé leur évolution. Dans le cadre de cette analyse nous tenterons d’évaluer la pertinence de la typologie de Roemer pour analyser les systèmes de santé actuels et, de façon plus importante, nous analyserons les systèmes après plusieurs années d’imposition de réformes orientées vers le marché

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“…The criteria were as follows: (1) is there a well-defined question; (2) is there a defined search strategy; (3) are inclusion/exclusion criteria stated; (4) are study designs and number of studies clearly stated; (5) have the primary studies been quality assessed; (6) have the studies been appropriately synthesised; (7) has more than one author been involved in each stage of the review process. Reviews were categorised as low (met 0-3 criteria), medium (4-5) or high (6)(7) quality.…”

Section: Data Extraction and Quality Appraisalmentioning

confidence: 99%

All Things Being Equal: Does it Matter for Equity How You Organize and Pay for Health Care? A Review of the International Evidence

Bambra¹,

Garthwaite²,

Hunter³

2014

Int J Health Serv

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Over the last 25 years, the health care systems of most high-income countries have experienced extensive—usually market-based—organizational and financial reforms. The impact of these system changes on health equity has been hotly debated. Examining evidence from systematic reviews of the effects of health care system organizational and financial reforms will add empirical information to this debate, identify any evidence gaps, and help policy development. Systematic review methodology was used to locate and evaluate published systematic reviews of quantitative intervention studies (experimental and observational) of the effects on equity in health care access and/or health status of health care system organizational and financial reforms (system financing, funding allocations, direct purchasing arrangements, organization of service provision, and health and social care system integration) in high-income countries. Nine systematic reviews were identified. Private insurance and out-of-pocket payments as well as the marketization and privatization of services have either negative or inconclusive equity effects. The evidence base on the health equity effects of managed care programs or integrated partnerships between health and social services is inconclusive. There were no relevant studies located that related to resource allocation reforms. The systematic review-level evidence base suggests that financial and organizational health care system reforms have had either inconclusive or negative impacts on health equity both in terms of access relative to need and in terms of health outcomes.

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The search for the Holy Grail: combining decentralised planning and contracting mechanisms in the French health care system

Cited by 38 publications

References 16 publications

Accounting and reimbursement schemes for inpatient care in France

Accounting and reimbursement schemes for inpatient care in France

Roemer 20 Years Later: When a Classical Health-System Typology Meets Market-Oriented Reforms

All Things Being Equal: Does it Matter for Equity How You Organize and Pay for Health Care? A Review of the International Evidence

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