DILEMME DES PRISES EN CHARGES AMBULATOIRES NON COUVERTES PAR LA CIRCULAIRE FRONTIÈRE : EXEMPLE DES SYNCOPES, UN PROBLÈME, UN COÛT, UNE SOLUTION

Sophie BOUVET; Christel CASTELLI; Jerome THEVENIN; Adeline ANDRE; Marion FAGES; Mamadou BALDE

doi:10.54695/jdds.039.01.97

Authors

Sophie BOUVET Département de Biostatistiques, Epidémiologie, Santé Publique et Innovation en Méthodologie (BESPIM), CHU Nîmes, Université Montpellier, Nîmes, France
Christel CASTELLI Département de Biostatistiques, Epidémiologie, Santé Publique et Innovation en Méthodologie (BESPIM), CHU Nîmes, Université Montpellier, Nîmes, France
Jerome THEVENIN Service de Cardiologie, Hôpital Privé de Loire, Saint Etienne, France
Adeline ANDRE Service DIM, Hôpital Privé de Loire, Saint Etienne, France
Marion FAGES Département Information Médicale GH Hôpitaux Universitaire Est Parisien, AP-HP, Assistance Publique - Hôpitaux de Paris
Mamadou BALDE Service Information Médicale, Méthodes Et Recherche (SIMMER), CHU Nîmes, Université Montpellier, Nîmes, France

DOI:

https://doi.org/10.54695/jdds.039.01.97

Keywords:

Flat rate payment; Optimization; Outpatient hospital care; Simulation; Health insurance expenses; Syncope

Abstract

Introduction - The purpose of the OCCO project is to improve the financing of outpatient hospital care that requires coordination or a specific technical platform. A first work allowed the description of these cares. This work aims at assessing the impact of introduction of a flat rate payment for these medical cares on the French health insurance expenses. The selected case is the medical management of syncope. Method - We used the decision tree method to estimate cost, a probabilistic Monte Carlo analysis to compare them and sensitivity analysis to test the robustness of the results. Results - The average cost of medical management of syncope in the current model is 888€ (sd=92€). In the proposed model, including a flat rate payment from 221.37€ to 247.91€, the average cost would be 854€ (sd=73€). This leads to a non-significant difference to the advantage of the new model. Conclusion - Introduction of flat rate payment for the medical management of syncope makes it possible to optimization of patient care and better match costs and revenues for hospitals without leading to extra expenses for health insurance.

References

Ingen-Housz-Oro S., Durand-Zaleski I., Cosnes A. et al. Hôpital de jour de dermatologie : entre circulaire frontière et réalité. Annales de dermatologie et de vénéréologie 2012;139:701-709.

https://doi.org/10.1016/j.annder.2012.03.009

Britten N. Qualitative research: qualitative interviews in medical research, BMJ 1995;311:251-53

https://doi.org/10.1136/bmj.311.6999.251

Krueger R.A., Casey M.A. Focus Groups: A Practical Guide For Applied Research, Sage Publications, 3rd edition, 2000.

http://www.qualitative-research.net/index.php/fqs/article/view/791/1718

Kitzinger J. Qualitative research: Introducing focus groups. BMJ 1995;311:299-302.

https://doi.org/10.1136/bmj.311.7000.299

Chkair S., Fages M., Castelli C. Les prises en charges ambulatoires non couvertes par la circulation frontière. Gestions Hospitalières Novembre 2016;561:592-596.

http://gestions-hospitalieres.fr/prises-charge-ambulatoires-non-couvertes-circulation-frontiere

The Task Force for the Diagnosis and Management of Syncope of the European Society of Cardiology (ESC), Guidelines for the diagnosis and management of syncope (version 2009). European Jeart Journal 2009;30:2631-2671.

https://doi.org/10.1093/eurheartj/ehp298

Rapport HAS : Recommandations professionnelles pour les Pertes de connaissance brèves de l’adulte : prise en charge diagnostique et thérapeutique des syncopes. Argumentaire mai 2008.

Day S.C., Cook E.F., Funkenstein H. et al. Evaluation and outcome of emergency room patients with transient loss of consciousness. Am J Med 1982;73:15-23.

https://doi.org/10.1016/0002-9343(82)90913-5

Silverstein M.D., Singer D.E., Mulley A. et al. Patients with syncope admitted to medical intensive care units. JAMA 982;248:1185-1189.

https://doi.org/10.1001/jama.1982.03330100023024

Morichetti A. and Astorino G. Epidemiological and clinical findings in 697 syncope events. Minerva Medica 1998;89:211-220.

https://pubmed.ncbi.nlm.nih.gov/9739353/

Soteriades E.S., Evans J.C., Larson M.G., Chen M.H., Chen L., Benjamin E.J., Levy D. Incidence and prognosis of syncope [archive]. N Engl J Med. 2002;347:878-885.

https://doi.org/10.1056/NEJMoa012407

Rose M.F.L. da Silva. Syncope: epidemiology, etiology, and prognosis. Frontiers in physiology Dec 2014.

https://doi.org/10.3389/fphys.2014.00471

Ministère des Solidarités et de la Sante. Arrêté du 28 février 2020 modifiant l’arrêté du 19 février 2015 relatif aux forfaits alloués aux établissements de santé mentionnés à l’article L.162-22-6 du code de la sécurité sociale ayant des activités de médecine, obstétrique et odontologie ou ayant une activité d’hospitalisation à domicile.

https://www.legifrance.gouv.fr/affichTexte.do?cidTexte=JORFTEXT000041661407&-categorieLien=id