Martine M. Bellanger

The “Health Benefit Basket” in France

The French “Health Benefit Basket” is defined principally by positive lists of reimbursed goods and services; however, global budget-financed hospital-delivered services are more implicitly defined. The range of reimbursable curative care services is defined by two coexisting positive lists/fee schedules: the Classification Commune des Actes Médicaux (CCAM) and the Nomenclature Générale des Actes Professionnels (NGAP). The National Union of Health Insurance Funds has been updating these positive lists since August 2004, with the main criterion for inclusion being the proposed procedure’s effectiveness. This is assessed by the newly created High Health authority (replacing the former ANAES). In addition, complementary health insurers are consulted in the inclusion process due to their important role in French healthcare financing.

What can we learn from a cross-country comparison of the costs of child delivery?

This study provides a comparative analysis of the costs of normal delivery in hospital in nine European countries using the data collected as part of the HealthBASKET project. The results show that both the level of input (medical labour) prices and the skill mix used for delivery are major determinants of total delivery costs. At the hospital level, there seems to be room for greater efficiency through specialisation and task shifting from doctors to midwives and nurses. More generally, the results of our study suggest that the costs of delivery in hospital are not independent of supplementary home care provided outside of hospitals. The cost information and analysis in this study may also be useful for developing healthcare-specific purchasing power parities (PPPs) that allow for healthcare expenditures to be compared across countries.

Tackling regional health inequalities in france by resource allocation : a case for complementary instrumental and process-based approaches?

This article aims to evaluate the results of two different approaches underlying the attempts to reduce health inequalities in France. In the ‘instrumental’ approach, resource allocation is based on an indicator to assess the well-being or the quality of life associated with healthcare provision, the argument being that additional resources would respond to needs that could then be treated quickly and efficiently. This governs the distribution of regional hospital budgets. In the second approach, health professionals and users in a given region are involved in a consensus process to define those priorities to be included in programme formulation. This ‘procedural’ approach is employed in the case of the regional health programmes. In this second approach, the evaluation of the results runs parallel with an analysis of the process using Rawlsian principles, whereas the first approach is based on the classical economic model.At this stage, a pragmatic analysis based on both the comparison of regional hospital budgets during the period 1992–2003 (calculated using a ‘RAWP [resource allocation working party]-like’ formula) and the evolution of regional health policies through the evaluation of programmes for the prevention of suicide, alcohol-related diseases and cancers provides a partial assessment of the impact of the two types of approaches, the second having a greater effect on the reduction of regional inequalities.