[The payer, the T2A pathway, the physician, the patient: the exemple of thoracic oncology].
BACKGROUND
For a few years, the French health system has implemented a lot of reforms which have consequences on patients' management, particularly in oncology.


METHODS
The main legislative texts are described. There were published after 2002-2007 hospital plan. These texts are analyzed according to several perspectives.


RESULTS
The implementation of the new fee scale (T2A: Tarification à l'Activité) is done according to the point of view of the payer with its economic basis. The T2A associates financing bound in relation to activity and other financed in supplement. The physicians'perspective can be in the opposite of the point of view of the payer, because they have to modify some management strategies. The patient's point of view can be dramatically opposite. A description of the ideal patient within the T2A pathway is secondary performed.


CONCLUSIONS
Each economical logic (the patients, the payer and the physicians) can be in opposition. Ethic has to be predominant and indicators, like practice guidelines and evaluation, have to balance economical considerations.
Vergnenègre
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Service de l'Information Médicale et de l'Evaluation, Hôpital du Cluzeau, Limoges cedex, France. alain.vergnenegre@unilim.fr
D019091:Critical Pathways; D005251:Fees, Medical; D005602:France; D006801:Humans; D007348:Insurance, Health; D008175:Lung Neoplasms / Q000191:economics* / Q000628:therapy; D010820:Physicians