Summary

In developed healthcare systems, the choice of hospital financing methods is managed by a third-party payer, whether public or private, depending on the organization of the country’s social protection system. Since 1950, France has explored several strategies to determine the resources required for the care of hospitalized patients. Three mechanisms have been implemented successively to establish hospital budgets: per diem rates, overall operating grant, and, finally, activity-based financing. These mechanisms helped to identify two key characteristics that needed to be improved. The first one was a day package where the bill was calculated on the number of days that the patient was hospitalized and not based on the treatment(s) required or made, and second, a better understanding of the care required for specific pathologies. The first mechanism was based on a per diem rate, calculated by dividing the total annual costs of the hospital by the number of patient days in the same year. The second mechanism involved using the budget of year N and applying a directive growth rate to determine the budget for year N+1. The third mechanism, inspired by a system introduced in the United States — Diagnosis Related Groups (DRG) — classifies patients based on their care needs into homogeneous patient groups or resource-consistent groups. This approach allows payers to understand precisely what they are financing. A brief comparison with the financing of private hospitals — based on the former national quantified objective (objectif quantifié national, OQN) — is also included. However, financing is only one element contributing to the efficiency of hospital care systems. The quality of care, strategic planning, and the collaboration of primary outpatient care providers also play crucial roles.