Reflections on approaches to hospital funding

Each way of financing the hospital—daily charges, funding, or activity-based pricing—has advantages and disadvantages. The choice should be made according to the particular activity concerned. T2A is suitable for standardized and programmed activities. Per-day charges are suitable for palliative care patients. Funding is suitable for complex activities involving rapid changes of treatment methods. This is particularly the case for chronic diseases or conditions that are becoming chronic, as in the case of a number of cancers. Each of these financing techniques requires a specific method of regulation that should be established in conjunction with the professionals. T2A was used not as a funding technique but rather as a policy to establish private management of hospitals. It functions not on the ethical principle of deserved care for the patient at the lowest cost to society, but according to the commercial principle of the search for profitability for the medical establishment in general. Competition between establishments was supposed to achieve quality at the lowest cost. The maintenance of a constrained national budget (ONDAM), the development of chronic diseases, and desire to limit hospital centralization have all led to a criticism of the “T2A as a whole,” yet the managerial powers remain attached to T2A, making the situation yet more complex.