French-style bundled payments? Revisiting an experiment in episode-based payment in orthopedics and oncology to improve coordination
Beaussier, Anne-Laure
French-style bundled payments? Revisiting an experiment in episode-based payment in orthopedics and oncology to improve coordination - 2022.
56
This article presents the initial results of a national experiment aimed at introducing episode-based bundled payments (EDS) in the French healthcare system. Launched in 2019, restricted for the moment to three pathologies (hip and knee replacement and colectomy for cancer) and to around forty hospitals, this experiment is presented as a step toward moving away from a much-criticized activity-based payment system in favor of a value-based payment system. EDS financing aims to pay healthcare organizations on the basis of a flat rate payment for a group of acts and services associated with a pathology before, during, and after hospital treatment. Coupled with quality objectives, bundled payments are expected to provide both quality and efficiency gains by incentivizing hospitals to optimize patients’ pathways and care coordination between acute care hospitals and primary care providers. Based on a qualitative empirical study, this article analyzes the extent to which the incentives associated with the introduction of this payment method participate in transforming care practices at the hospital level. Taking a multidisciplinary approach (health policy and management and health sociology) and examining the literature on management tools, policy instruments, and algorithmic regulation, we show that the financing framework used to calculate reimbursement packages does not yet produce the expected incentives in terms of care coordination.
French-style bundled payments? Revisiting an experiment in episode-based payment in orthopedics and oncology to improve coordination - 2022.
56
This article presents the initial results of a national experiment aimed at introducing episode-based bundled payments (EDS) in the French healthcare system. Launched in 2019, restricted for the moment to three pathologies (hip and knee replacement and colectomy for cancer) and to around forty hospitals, this experiment is presented as a step toward moving away from a much-criticized activity-based payment system in favor of a value-based payment system. EDS financing aims to pay healthcare organizations on the basis of a flat rate payment for a group of acts and services associated with a pathology before, during, and after hospital treatment. Coupled with quality objectives, bundled payments are expected to provide both quality and efficiency gains by incentivizing hospitals to optimize patients’ pathways and care coordination between acute care hospitals and primary care providers. Based on a qualitative empirical study, this article analyzes the extent to which the incentives associated with the introduction of this payment method participate in transforming care practices at the hospital level. Taking a multidisciplinary approach (health policy and management and health sociology) and examining the literature on management tools, policy instruments, and algorithmic regulation, we show that the financing framework used to calculate reimbursement packages does not yet produce the expected incentives in terms of care coordination.
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