Costs, payments, productivity, and working conditions in hospitals

Abstract

In 2013 several reports were dedicated to the impacts of the T2A (Tarification à l’activité, the French case-mix-based prospective paymentsystem). They all emphasized the increase of hospital activity, which is the easiest evolution to quantify. The analyses of the other impacts of the T2Aare more scarce: quality of care and patient safety are approached by partial quantifications, in one business segment or another. At this stage they do not seem to show the potential adverse effects of the new financing system. The working conditions of the hospital staff are not even considered. yet several quantitative studies and researches, using comparisons between expenses and payments, suggest that the hospital productivity regularly increased during these last years. Besides they suggest that these productivity gains mostly concern the paramedical staff. on the other hand qualitative analyses seem indicate that the working situations within hospitals are harder and harder. It is suggested to include this theme in the future evaluations of the T2A.