Hospitals’Activity based financing: dead-ends and solutions

Abstract

Activity based tariffs were first tested by the Medicare insurance and then generalized in the United States, before spreading to most western European countries, including France, where it took the name of “Tarification à l’activité (T2A)” from 2008. The expected efficiency of this principle is based on yardstick competition. The T2A is now challenged by the limitations of the practical application of theoretical incentive principles. Solutions are explored in this article. Their objective is to reintroduce an economic component in the calculation of costs and to charge according to good medical practices. In addition, since the care of the patient is part of a healthcare institution, it is necessary to take into account its productive constraints and its organization.