Multi-Perspective Analysis of Hospital Costs in France: Case Study on the French System

OBJECTIVES: Understanding healthcare costs from various perspectives—patients, healthcare providers, and health insurance—is crucial in the French context to nourish medico-economic evaluations. Each stakeholder faces unique challenges and bears different burdens. A study based on a random sample of patients from the French National Health Data System (SNDS) was performed to assess hospitalization costs from these various perspectives.

METHODS: A retrospective observational study was conducted using the French National Claims Database (SNDS). A random sample of adult patients was included in 2015. A 6-year study period was used to collect healthcare resource use utilization (HCRU), including hospitalizations. Hospitals costs were valued and described with the following perspectives: National Health Insurance (NHI) tariffs and costs incurred for hospitals. The SNDS gives direct access to the calculated tariffs and costs, ready for analysis. We have also recalculated them from the official tariffs set annually at the national level (T2A activity), as well as based on the average costs per stay determined from the annual survey ENC. Split between public and private hospitals was made to take into account differences of calculation.

RESULTS: In 2015, 71,740 patients were included in the study. Among them, 58.0% were men, and 37.5% were under the age of 64. The average number of hospitalized patients per year between 2015 and 2021 was 17,935, with an average of 3.2 hospitalizations per patient. The mean reimbursed cost per patient from a NHI perspective was €7,226 (±12,330), whereas the mean cost per patient from hospital perspective was €7,312 (±11,843) per patient.

CONCLUSIONS: These results underscore the importance of the various perspectives considered in France for medico-economic evaluations and highlights the difference between the various methods to calculate them, which help to get a comprehensive evaluation of healthcare costs and inform policymakers to optimize resource management in the healthcare sector.