La tarification à l'activité : une réforme dénaturée du financement des hôpitaux

This article analyzes the properties of the so-called « T2A » DRG-based hospital payment policy implemented in France since 2004. The limits of this policy, whose aim is to induce productive efficiency, are studied in the first part. It is shown that serious drawbacks come from the lack of credibility, the price inelasticity of demand, the effects on quality of health care and of patient and hospital heterogeneity. In the second part, it is shown that the current implementation has led to a very complex procedure, in contradiction with the initial aim. As a result, T2A looks more like a cost reimbursement mechanism associated with an activity-based splitting of a budgetary envelop.