[Illness-based payment to hospitals: the French experience]

Since 1991, the French government is experiencing case based prospective payment mechanisms for public and for profit private hospitals. The experiments are the final objective of a program launched in 1982 to implement Diagnosis Related Groups (DRG) in France. Experiments are described and discussed. The relevance of the DRG classification is questioned, as well as the potential incentives embedded in the payment scheme. In the public sector, a case based prospective budgeting method is tested, to re-allocate resources according to case mix and relative costs. In the for profit sector, a prospective payment per case is designed, with price and volume adjustment inside a global cap of expenses. The experiments are a first step towards the unification of payment methods in both sectors. But important differences still remain, dealing with the scope of the payment method and the rate-setting basis. All expenditures will be covered in the public sector, physician fees are excluded in the private sector. The rates are based on actual cost in the public sector, on actual bills for the private sector.