Deprivation and Hospital Payment Method: in Favour of Weighting Tariffs with Patients' Level of Deprivation

Karine CHEVREUL

Morgane MICHEL * Université de Paris ; Inserm UMR 1123 ; Assistance Publique-Hôpitaux de Paris (AP-HP). Contact : karine.chevreul@inserm.fr.Les autrices remercient Christel Dindorf (datamanager à l'unité de recherche clinique en économie de la santé à l'AP-HP) pour le traitement des données, ainsi que Rémi Flicoteaux (médecin DIM à l'AP-HP) et Pierre Rosmorduc (directeur des finances adjoint au GHU AP-HP.Nord) pour l'accès aux données et les nombreux échanges constructifs autour de celles-ci.

Patients' deprivation is associated with increased hospital costs, which are currently funded through an envelope whose lump sum is distributed among eligible hospitals, i.e. those over a certain threshold of deprived patients. In this model, deprivation is measured through social benefits, meaning that only the most deprived are identified as such. However, a growing body of the literature is reporting an association between deprivation and increased length of stay and hospital costs all along the social gradient, and not just at its extremity. It is therefore time to rethink how deprivation is accounted for in hospital payment methods, both in terms of indicators used to identify deprived patients and mode of payment. In this context, a modulation of hospital tariffs based on patients' deprivation level, measured by an ecological indicator, would improve the allocative efficiency of the healthcare system.