It is one of the most criticized symbols of the “hospital-business” that the 2024 Social Security financing bill, presented on September 27 and examined in the Hemicycle from October 24, promises to attack. Activity-based pricing, nicknamed “T2A” in hospital jargon, is the current system of financing public and private health establishments, in medicine, surgery and obstetrics, should, from 1er January 2025, give way to a new model. Without disappearing.
Establishments will receive new types of remuneration, based, on the one hand, on “public health objectives” and, on the other hand, on “specific missions”but activity-based pricing remains the third pillar for allocating resources to hospitals.
Figure policy, race for profitability, competition between establishments… Criticism has continued to rain down, from the mouths of doctors, on this allocation method deployed in 2004, and generalized in 2008. “The worst, except all the others”we nevertheless temper our defenders.
Emmanuel Macron turned a technical subject into a political issue: “We must move away from activity-based pricing as of the next Social Security financing bill”said the President of the Republic on January 6, during his wishes to health stakeholders. “When systems are installed and we say that we are going to change them gradually, that doesn’t work, we have to proceed differently”he maintained, even though he had already promised, for his first five-year term, to roll back the T2A.
Progressive path
To date, the hospital’s activity is classified according to the patient’s profile, their diagnosis, the medical procedures carried out, etc. These are the homogeneous groups of patients (GHM). For each group, an average cost of care is estimated, then a rate is assigned to it by the State. It is this rate which is then paid by Health Insurance to the hospital. But, for years, the dropping of numerous prices in relation to the reality of costs and the use of this lever to constrain the hospital budget have been widely denounced.
Despite the presidential promise resembling a big bang, the path that is emerging will nevertheless be progressive and the new model assumed as “mixed”. The discrepancy appeared the day after Emmanuel Macron’s wishes, in the words of the then Minister of Health, François Braun, who spoke of the exit of the “all-T2A”. One more word that changes the situation.
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