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Le service public hospitalier est-il soluble dans la tarification à l’activité… et vice et versa ? Volume 83, issue 7, Septembre 2007

Author
Directeur adjoint, Centre hospitalier, Quartier Saint-Christophe, 04 003 Digne-les-Bains Cedex

Are public hospital services compatible with activity-based tariff scales… and vice versa?Since the mid 20th century, public services have been at the heart of a vision for society based on solidarity and social interdependence. Together with social insurances, they have created a new type of citizenship based on social propriety. The growing importance in the past twenty years of market-based systems of regulation is at odds with this original idea of public service. Hospitals are not exempt from this contradiction, particularly since the setting up of the funding reform. The new activity-based tariffs and ensuing revolution, notably in terms of management logic and the emergence of the idea of cost-effectiveness, are in danger of overturning the definition of this notion of public service, all the more so since Europe is at the forefront of the liberal revolution. The safeguard of our social contract is thus at risk.