Does hospital investment benefits from the regionalization “à la française”? (original) (raw)

Abstract

In France, since 1996, a new actor is in charge of the hospital regulation and resource allocation within the hospital regional system. Under the name of “ARH” (for hospital regional agency) this Institution is a mix of genuine “decentralization” and fake “deconcentration”. It is supposed to organize the restructuring of the hospital system, at the regional level, thanks to a whole set of management and regulatory tools. Among them, the five year contract that each hospital has to sign with its agency is the most important. Named COM (Objectives and resources contract), this contract is the result of internal negotiation between hospital actors (namely, physicians and managers) ; it is also the result of external negotiation as it has to take into account regional priorities (in terms of medical activities, supply reorganization, etc.). The ARH Director is supposed to coordinate those decisions and to allocate resources, among hospitals, according to those contracts. Therefore, investing in hospital is the outcome of explicit and negotiated decision making process involving a growing number of stakeholders (experts, hospital staff, physicians, managers, administrative managers, etc.). >From the whole process, policy makers expect that investment decision will be more rationale, more accurate as far as efficacy and equity are concerned. The political bet is that contractualisation, restructuration and a high level of investment will led to a cut in the number of short term beds while maintaining a high quality level. The main hypothesis tested is that there is a positive correlation between the reform implementation and the level of the investment at the regional level. Taking this context into account, this communication assesses the impact of this reform on the hospital investment. Regressions will be computed where dependent variables are the investment expenses (by region, type of hospitals, type of investment, etc.) and independent variables are proxies of hospital regional system supply (e.g. bed density by region) and the effectiveness of a regional policy (e.g. number of Contracts).

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