From cost to tariffs per pathology. Lessons from an attempt of transposing the French T2A to the Belgian hospital financing system

Abstract

The Belgian hospital financing system is criticized for its complexity and its lack of transparency. The Ministry has expressed its willingness to introduce a pricing to pathology. The main objective of this article is to describe the problem of moving from a calculation of cost per pathology to the development of tariffs based on an experience inspired by the methodologies developed within the French T2A. In practice, the data from ten Belgian hospitals (2012) is used to analyze the ability to transpose the French method of constructing tariffs per pathology (T2A) to the Belgian context. In coherence with the French method, a perimeter of pricing is defined based on the overall actual budget received by these 10 hospitals. This perimeter represents 35.62% of the actual budget of these 10 hospitals. The gap between the initial endowment and the amount after allocation based on tariffs per pathology ranges from -11,94% to +15,38% according to the hospital. The introduction of a pricing to pathology in Belgium requires in-depth work to determine a tariff base and mechanisms of alternative financing for missions apart from this tariff base. A standardized system of costing by diseases to create a national (or regionals) costs scale(s) should be implemented by the authorities. The foreseeable impact of the reform of the financing should prompt hospitals to give more attention to control their costs than to increase their turnover.