Choné Philippe
CREST (Centre de Recherche en Economie et Statistique), 15 boulevard Gabriel Péri, 92245 Malakoff, France.
Health Policy. 2017 Feb;121(2):111-118. doi: 10.1016/j.healthpol.2016.11.015. Epub 2016 Nov 24.
There are more than two thousand hospitals in France, about equally divided between government-owned and privately-owned hospitals. Activity-based payment, which has been generalized in 2008 for acute care hospitals, has raised competition issues as DRG tariffs differ according to ownership status. Furthermore, the payment rule has been criticized for preventing the realization of potential hospital synergies, and as a result a recent reform has mandated close cooperation between public hospitals. The physician market is dual, with most GPs being subject to fee regulation and many self-employed, private-practice, specialist doctors being allowed to set their prices freely. Government regulation and centralized negotiations have traditionally been preferred to market mechanisms in this industry.
法国有两千多家医院，公立医院和私立医院数量大致相当。基于活动的支付方式于2008年在急症医院普遍推行，由于诊断相关分组（DRG）费率因所有权状况而异，引发了竞争问题。此外，该支付规则因阻碍医院潜在协同效应的实现而受到批评，因此最近的一项改革要求公立医院之间密切合作。医生市场具有双重性，大多数全科医生受到费用监管，许多个体经营的私人执业专科医生可以自由定价。在这个行业中，传统上更倾向于政府监管和集中谈判而非市场机制。
