Combining budget cuts and efficiency of hospitals in France and the United Kingdom: the example of the tariff policy for day surgery

Isabelle Hirtzlin ()
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Isabelle Hirtzlin: CES - Centre d'économie de la Sorbonne - UP1 - Université Paris 1 Panthéon-Sorbonne - CNRS - Centre National de la Recherche Scientifique

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Abstract: Activity-based tariff for hospitals were first implemented in the US and extended to Europe in the 1990s. By paying a flat rate tariff by stay it promotes a reduction of its medium length. Therefore it should have theoretically increased the proportion of day surgery in hospitals. However, a tariff deduction was initially made for day surgery. This have contributed to the delay in the implementation of day surgery activities in several countries, including France and the UK. In the early 2000s, in order to promote day surgery which is reputed to cost less, the regulation bodies of both countries adopted a same tariff principle for day surgery and full hospitalisation, for a given list of surgical procedures. The UK went further in 2010 with the introduction of a best practice tariff. It opened the possibility to pay more for day surgery than for full hospitalisation. These measures try to conciliate allocative efficiency for the health care system and productive efficiency of hospitals. Nevertheless, nowadays, neither of the two countries could be sure that this policy will contribute to reduce the global budget allocated to surgery and satisfy the national budget constraints.

Keywords: Best pratice tariff; Activity based tariff; Day surgery; austerity; France; United Kiingdom; Tarification à la meilleure pratique; Tarification à l'activité; chirurgie ambulatoire; austérité; Royaume uni (search for similar items in EconPapers)
Date: 2016-12-02
New Economics Papers: this item is included in nep-knm
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Published in L’État et les services publics à l’ère des restrictions budgétaires : regards croisés France – Royaume-Uni, Université de Paris 1, France Stratégie, Fondation Gabriel Péri Dec 2016, Paris France

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