title: [Precariousness, DRG's and health planning: pilot study at the Lariboisière hospital in Paris].
abstract: OBJECTIVE
  This paper considers the specific administrative procedures set up by managers of public healthcare establishments and those responsible for health and welfare policies to care for low-income pregnant women for whom 100% of the "price per act" (T2A) is refunded. What are the limitations and what improvements can be suggested?
  
  
  METHODS
  The results are based on an analysis of data from semi-structured interviews, legislation and documents.
  
  
  RESULTS
  The State, health insurance systems, public health establishments, local authorities, charities and outpatient services are involved in handling low-income parturients in different services and different establishments, both locally and regionally. A health and welfare policy comprising specific, coordinated actions and measures has been developed. The T2A "price per act" system may threaten its survival: the limited number of front-line facilities is often saturated and demand is increasing, treatment is often reduced to reactive management leading to unwanted readmissions, ethics are sometimes called into question and there is a risk of patient selection.
  
  
  CONCLUSIONS
  This pilot study provided some encouraging information but also indicated the limitations of the approach adopted. However, it was still of interest to see whether it was possible to use this approach, which did not require considerable resources, to reveal useful markers. This appeared to be the case. Regional Health Agencies (ARS) and local authorities could support the system. Additional funding is needed.
authors.affiliation: Module interprofessionnel de santé publique 2009, école des hautes études en santé publique EHESP, avenue du Professeur-Léon-Bernard, 35043 Rennes cedex, France.
authors.forename: C
authors.initials: C
authors.lastname: Mainpin
authors.forename: C
authors.initials: C
authors.lastname: Blond
authors.forename: F
authors.initials: F
authors.lastname: Bottin
authors.forename: B
authors.initials: B
authors.lastname: Gézéquel
authors.forename: M
authors.initials: M
authors.lastname: Guillemot
authors.forename: M
authors.initials: M
authors.lastname: Horvath
authors.forename: M
authors.initials: M
authors.lastname: Muller
authors.forename: V
authors.initials: V
authors.lastname: Prat
authors.forename: O
authors.initials: O
authors.lastname: Morel
authors.forename: E
authors.initials: E
authors.lastname: Barranger
authors.forename: P-H
authors.initials: PH
authors.lastname: Bréchat
mesh_terms: D003953:Diagnosis-Related Groups / Q000191:economics / Q000941:ethics / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D005260:Female; D006285:Health Planning / Q000191:economics / Q000941:ethics / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D006739:Hospital Administration / Q000191:economics* / Q000941:ethics / Q000331:legislation & jurisprudence; D006801:Humans; D010297:Paris; D018579:Patient Selection / Q000941:ethics; D010865:Pilot Projects; D011203:Poverty / Q000191:economics / Q000941:ethics / Q000331:legislation & jurisprudence; D011247:Pregnancy