French-style bundled payments ? Feedback on an experiment in episode-based payment in orthopaedics and oncology to improve coordination

Des bundled payments à la française ? Retours sur une expérimentation du paiement à l’épisode de soins en orthopédie et oncologie pour améliorer la coordination

Anne-Laure Beaussier (), Anne Girault (), Odessa Petit Dit Dariel (), Magali Robelet () and Alice Valiergue ()
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Anne-Laure Beaussier: CSO - Centre de sociologie des organisations (Sciences Po, CNRS) - Sciences Po - Sciences Po - CNRS - Centre National de la Recherche Scientifique
Anne Girault: ARENES - Arènes: politique, santé publique, environnement, médias - UR - Université de Rennes - Institut d'Études Politiques [IEP] - Rennes - EHESP - École des Hautes Études en Santé Publique [EHESP] - UR2 - Université de Rennes 2 - CNRS - Centre National de la Recherche Scientifique, EHESP - École des Hautes Études en Santé Publique [EHESP], IDM - Institut du Management - EHESP - École des Hautes Études en Santé Publique [EHESP], RSMS - Recherche sur les services et le management en santé - UR - Université de Rennes - EHESP - École des Hautes Études en Santé Publique [EHESP] - INSERM - Institut National de la Santé et de la Recherche Médicale - CNRS - Centre National de la Recherche Scientifique
Odessa Petit Dit Dariel: ARENES - Arènes: politique, santé publique, environnement, médias - UR - Université de Rennes - Institut d'Études Politiques [IEP] - Rennes - EHESP - École des Hautes Études en Santé Publique [EHESP] - UR2 - Université de Rennes 2 - CNRS - Centre National de la Recherche Scientifique, RSMS - Recherche sur les services et le management en santé - UR - Université de Rennes - EHESP - École des Hautes Études en Santé Publique [EHESP] - INSERM - Institut National de la Santé et de la Recherche Médicale - CNRS - Centre National de la Recherche Scientifique, EHESP - École des Hautes Études en Santé Publique [EHESP], IDM - Institut du Management - EHESP - École des Hautes Études en Santé Publique [EHESP]
Magali Robelet: CMW - Centre Max Weber - ENS de Lyon - École normale supérieure de Lyon - Université de Lyon - UL2 - Université Lumière - Lyon 2 - UJM - Université Jean Monnet - Saint-Étienne - CNRS - Centre National de la Recherche Scientifique
Alice Valiergue: CSO - Centre de sociologie des organisations (Sciences Po, CNRS) - Sciences Po - Sciences Po - CNRS - Centre National de la Recherche Scientifique, EHESP - École des Hautes Études en Santé Publique [EHESP]

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Abstract: This article presents the initial results of a national experiment aimed at introducing episode-based bundled payments 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 40 hospitals, this experiment is presented as a step to move away from a much criticized activity-based payment system and to promote value-based payment. Episodes of care's 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 upstream, during and downstream of in hospital surgery. Coupled with quality objectives, bundled payments are expected to support 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 to transform care practices at the hospital level. Building on a multidisciplinary approach (health policy and management and health sociology) and reflecting on the literature on management tools, policy instruments and algorithmic regulation, we show that the financing framework used to calculate the reimbursement package does not yet produce the expected incentives in terms of care coordination.

Keywords: episode of care; bundled payment; coordination; health; financing; épisode de soins; paiement au forfait; santé; financement (search for similar items in EconPapers)
Date: 2022
Note: View the original document on HAL open archive server: https://hal.science/hal-03925625v1
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Published in Politiques et Management public, 2022, 39 (3), pp.297-316. ⟨10.3166/pmp.39.2022.0018⟩

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Persistent link: https://EconPapers.repec.org/RePEc:hal:journl:hal-03925625

DOI: 10.3166/pmp.39.2022.0018

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