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Du PMSI à la T2a, de la fiche par patient au RIMpsy : la grande peur de la VAP Volume 83, issue 7, Septembre 2007

Author
Psychiatre des Hôpitaux, Médecin-chef à l’Association santé mentale du XIII e arrondissement de Paris, FFDIM, 11 rue Albert-Bayet, 75013 Paris

From PMSI to activity-based tariffs, from patient file to RIMpsy: the great fear of the VAP (activity based valuation in psychiatry)While public hospitals in France are quaking under the combined effects of two violent restructuring initiatives – activity-based tariffs and national quantified objectives – private clinics are becoming an increasingly attractive alternative for placements. Sector psychiatrists and directors of mental health centres have until now succeeded in protecting public psychiatric budgeting from the kind of upheavals experienced in general medicine, surgery and obstetrics. Looking beyond the overall advantages and disadvantages of a global budget, which are detailed here, the psychiatry budget funds both in-house and extramural activities, in an envelope covering prevention, treatment and post-cure. A large part of a sector team’s room for manoeuvre and capacity to adapt to their work context is due to the latitude with which this funding is spread over these three areas. By enabling means to precede activity, this system also has advantages in terms of planning. On the other hand, funding for general interest missions is centralised, bureaucratic and short-term. Sector psychiatry, an activity which will be better apprehended thanks to the RIM-psy, deserves adequate funding based on thorough planning. The fervour of those actors from private clinics who are demanding an immediate “convergence between public-private tariffs” is putting this process in danger.