title: Characteristics and patterns of elective admissions to for-profit and not-for-profit hospitals in France in 2009 and 2010.
abstract: In the mid 2000s, in an effort to increase competition among hospitals in France - and thereby reduce hospital care costs - policymakers implemented a prospective payment system and created incentives to promote use of for-profit hospitals. But such policies might incentivize 'upcoding' to higher-reimbursed procedures or overuse of preference-sensitive elective procedures, either of which would offset anticipated cost savings. To explore either possibility, we examined the relative use and costs of admissions for ten common preference-sensitive elective surgical procedures to French not-for profit and for-profit sector hospitals in 2009 and 2010. For each admission type, we compared sector-specific hospitalization characteristics and mean per-admission reimbursement and sector-specific relative rates of lower- and higher-reimbursed procedures. We found that, despite having substantially fewer beds, for-profit hospitals captured a large portion of market for these procedures; further, for-profit admissions were shorter and less expensive, even after adjustment for patient demographics, hospital characteristics, and patterns of admission to different reimbursement categories. While French for-profit hospitals appear to provide more efficient care, we found coding inconsistencies across for-profit and not-for-profit hospitals that may suggest supplier-induced demand and upcoding in for-profit hospitals. Future work should examine sector-specific changes in relative use and billing practices of for elective surgeries, the degree to which these elective surgeries are justified in either sector, and whether outcomes differ according to sector used.
authors.affiliation: The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH 03766, USA; The Aix-Marseille School of Economics, Marseille, France. Electronic address: wbw@dartmouth.edu.
authors.forename: William B
authors.initials: WB
authors.lastname: Weeks
authors.affiliation: SESSTIM, UMR 912 INSERM-IRD-Aix-Marseille Université, Marseille, France; Observatoire Régional de la Santé PACA, Marseille, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Jardin
authors.affiliation: The Aix-Marseille School of Economics, Marseille, France; SESSTIM, UMR 912 INSERM-IRD-Aix-Marseille Université, Marseille, France; Observatoire Régional de la Santé PACA, Marseille, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Paraponaris
mesh_terms: D017558:Elective Surgical Procedures / Q000706:statistics & numerical data*; D005602:France; D006301:Health Services Needs and Demand; D006302:Health Services Research; D017721:Hospital Costs; D006777:Hospitals, Proprietary / Q000191:economics / Q000706:statistics & numerical data*; D006779:Hospitals, Public / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007349:Insurance, Health, Reimbursement; D007902:Length of Stay / Q000191:economics; D010343:Patient Admission / Q000191:economics / Q000706:statistics & numerical data*; D012044:Regression Analysis
keywords: Elective surgical procedures; For-profit hospitals; France; Health economics; Healthcare delivery science; Hospitalization costs; Not-for-profit hospitals; Supplier-induced demand