Isabelle Hirtzlin

Université de Paris 1 Panthéon-Sorbonne | UNiVPARIS1 · Graduate School of Economics

Introduction La loi de modernisation de notre système de santé (26 janvier 2016) comprend la mise en place des groupements hospitaliers de territoire (GHT). L’information médicale fait partie des fonctions mutualisées et placées sous la responsabilité de l’établissement support. L’étude réalisée vise à présenter l’impact des GHT sur l’organisation...

Hospitals’ Activity based financing: dead-ends and solutions Activity based tariffs were first tested by the Medicare insurance and then generalized in the United States, before spreading to most western European countries, including France, where it took the name of “Tarification à l’activité (T2A)” from 2008. The expected efficiency of this princ...

Hospital at home chemotherapy in France : organization and tariffs.

Introduction Les pouvoirs publics souhaitent développer l’hospitalisation à domicile (HAD) à l’horizon 2018 et s’interrogent sur la place de la chimiothérapie en HAD. Peu de données françaises sont disponibles sur cette activité en HAD. L’analyse du PMSI HAD conduite par la Haute Autorité de santé (HAS) a permis de la caractériser et d’identifier l...

Conditions du développement de la chimiothérapie en hospitalisation à domicile : analyse économique et organisationnelle, HAS, JANVIER 2015 SERVICE ÉVALUATION ÉCONOMIQUE ET SANTÉ PUBLIQUE

Since 3rd October 2013 in France, drug companies applying for reimbursement of an innovative and expensive drug or medical device are required to provide the French National Authority for Health (HAS) with a cost-effectiveness assessment of their product. After a methodological audit of the economic evaluation submitted by the drug company, the Hea...

Day surgery allows the patient to return home the same day of surgery. This practice highly developed in many European countries and became a large majority of surgery, while it still represents only 40 % of total surgeries in France. To encourage the development of day surgery, a single tariff between day and conventional surgery was introduced by...

This report is an overview of knowledge produced about day surgery in the French and international literature. It includes the definitions of ambulatory surgery and a point on the French legislation, the description of the environment and different ways of organizing day surgery, an analysis of risk / benefit for patients, an overview of its develo...

Les services de soins de suite et de réadaptation correspondent à l’une des activités des établissements de santé. L’orientation vers une structure de SSR est nécessaire pour le traitement de certaines pathologies, dont la sévérité et la complexité requièrent une hospitalisation. L’objectif du présent rapport est de présenter un outil d’aide à la d...

In 2004, France implemented a national mammographic breast cancer screening programme for women aged 50 to 74 years. Women can retain the option of having an opportunistic screening mammography under medical prescription, however data on opportunistic screening are lacking. By analysing the National Health Insurance scheme database (EGB) and a data...

En France, le dépistage du cancer du sein peut être réalisé dans le cadre du programme national de dépistage organisé (DO) ou sur-prescription (dépistage individuel (DI)). La population cible du DO est celle des femmes de 50 à 74 ans. L’existence du DI peut constituer un obstacle au rendement du DO par une diminution de la participation au programm...

In 1998 the Fifty-first World Health Assembly passed the "health-for-all policy for the twenty-first century". During this assembly the Member States of the World Health Organization (WHO) reaffirmed their commitment to the principle that "the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human bei...

In France, people obtain basic health insurance coverage through a public health insurance system. Although public coverage is comprehensive, substantial co-payments and deductibles are more and more required and individuals become increasingly dependant on private complementary health insurance, to be better reimbursed. In the context of strengthe...

This paper deals with the organizational change in the provision of care for rare diseases, and the creation of a new structure: the centre of reference for rare diseases (CRMR). It aims to show that this new organization of care introduces a new authority within the healthcare organizational structure, by referring of the Transaction costs paradig...

In France a National Objective for Health Insurance Spending (ONDAM) is annually voted by the Parliament since 1996 and is divided into four sub-groups corresponding to a category of care. We describe how the initial diversity in providers' payment rules conduced to particular regulation procedures for each of them. We then show how the failure of...

The life expectancy of patients with Marfan's syndrome has been increased by over 30 years by modern medico-surgical management but the diagnostic problems related to the multiplicity of symptoms and the necessity of collaboration by many specialities complicate the medical history of patients, which is largely unknown. The authors sent a self-admi...

Type 2 diabetes mellitus may go undiagnosed for several Years while complications are silently developing. In France, from 2 to 3.7% of adults aged 35-65 are unaware they have diabetes. Nevertheless fasting serum glucose is a simple diagnostic test. We described people who underwent opportunist diabetes screening (serum glucose) within 2 Years (200...

Position du problèmeLe diabète de type 2 peut évoluer à bas bruit pendant plusieurs années et conduire à de graves complications. En France, les estimations de la prévalence du diabète méconnu sont imprécises et concerneraient de 2,0 à 3,7 % de la population âgée de 35 à 65 ans. Pourtant la glycémie veineuse est un test de pratique simple, qui perm...

In 2002, the National Agency for Health Assessment and Accreditation (ANAES) has driven an economic literature review on the direct medical cost of diabetes type 2 in France. According to the studies, the total cost per diabetic is between 2350 € (in 1998) and 3914 € (in 2002). Hospitalisation costs are the highest: they represent 42 to 50.5% of th...

Biobanks correspond to different situations: research and technological development, medical diagnosis or therapeutic activities. Their status is not clearly defined. We aimed to investigate human biobanking in Europe, particularly in relation to organisational, economic and ethical issues in various national contexts. Data from a survey in six EU...

Results of breast cancer screening mostly depend on the aptitude of organizers to ascertain that screened cases will effectively receive treatment in the right time. A study was designed to assess the potential of the information system of the Self-employed National Sickness Fund (CANAM) in analysing post screening patient following management and...

Orphan diseases are serious and unknown chronic diseases, for which a rapid diagnosis may provide a better access to healthcare. The aim of this study was to describe the procedures of diagnosis for patients with such ailments. Self-administered questionnaires describing patient's behavior, medical examinations until the final diagnosis, as well as...

Background: Orphan diseases are serious and unknown chronic diseases, for which a rapid diagnosis may provide a better access to healthcare. The aim of this study was to describe the procedures of diagnosis for patients with such ailments. Methods: Self-administered questionnaires describing patient's behavior, medical examinations until the final...

New Social Security financing Laws have been voted in France in 1996. Using national health insurance data and health care system managers interviews, this paper analyses the role of one of the main tool of the reform : the National Objective for Health Care Expenses (ONDAM). The ONDAM should be able to regulate health care expenditures and to info...

This study is measuring the average cost of the medical follow-up for high cardio-vascular risk patients in a hospital preventive medicine centre. 100 patients were randomly selected: 50 from the data base of 1993 and 50 from the data base of 1994. The costs have been calculated for 10 years and compared to the medical savings due to the avoidance...

Après avoir brièvement défini le concept de coopération en utilisant les outils proposés par l'économie des coûts de transaction, nous montrons que, dans le secteur de la santé (en particulier pour les établissements hospitaliers et de recherche médicale), la coopération avec différents partenaires publics ou privés est aujourd'hui largement encour...

These last few years have witnessed an important expansion of human biological samples collecting. The purpose in so doing is to exploit and study the genetic information collected. Laboratories which store samples usually do so as a side activity to their clinical or research activities. Human DNA, tissue or cell banks are necessary for a wide ran...

In the last few years, the activity of research laboratories has led to the emergence of new DNA diagnostic tests in France. They permit the origin of genetic diseases to be identified and provide an answer concerning the detection of carriers and prevention. Nevertheless, given this, new actors have emerged on the health care scene: the research w...

Mental retardation is sometimes due to chromosomal abnormalities. Most frequent illnesses are Down syndrome and Fragile X syndrome. Using a cost analysis, we try to see what diagnosis method is the most relevant to find chromosomic causes for mental retardation in an institutionalized male population. Two techniques are compared: cytogenetic techni...

In 1998 the Fifty-first World Health Assembly passe d the "health-for-all policy for the twenty-first century". During this assembly the Member States of the World Health Organization (WHO) reaffirmed their commitment to the principle that " the enjoyment of the highest attainable standard of health is one of the fundamental rights of every hu man...