The Incentive Effects of DRGs’ Reimbursement Rates for Health Care Establishments in France: Towards a New Allocation of Surgical Procedures?

This paper describes and analyses, in the French context, the effects of the diagnosis related groups (DRGs) on surgical procedures in public and private health care establishments through an analysis of annual data extracted from the PMSI medico-administrative computerised database programme for the years 2005 and 2008. A statistical analysis conducted at a national level on surgical GHMs (homogeneous groups of patients) shows that there is no such effect in the choice of the type of group (with or without CAM complications and associated morbidities) by health care establishments. However, the study reveals an increase in coding, irrespective of the sector (private or public), since the implementation of the DRGs for the same homogeneous groups of patients. This research presents the originality of measuring the effects of the DRGs on the surgical activity of health care establishments within the French context by using a significant quantitative database. To our knowledge, this is the first research in this field of comparison between the public and private establishments financing since the implementation of the DRGs in 2005.