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Protest strikes and demonstrations meet France’s attempt to introduce a new payments system for hospital treatments

The introduction of a new computerised coding system has sparked strikes and demonstrations in hospitals across France. The new coding system was loaded onto patient management systems in 100 of France's 616 state-run public hospitals in January, resulting in three days of action so far: December 16, January 22 and March 11.

Four hospital worker’s unions, the CGT — France's largest trade union — FO, SUD and CFTC have combined with three doctors and nurses' unions, INPH, CHG and Amuhf to co-ordinate picketing of French members of parliament, rallies and strikes.

The 'Codage', the national computer-driven healthcare and cost-coding system, has become the flashpoint for widespread resistance to the French Government's attempted reforms of both the state hospital and sickness-benefits systems.

The French Government is attempting a wholesale reform of the public sector. Attempts to reform the public pensions system, reducing pay-outs and tightening up the rules, led to enormous public demonstrations against the Government last year.

The Government initiative to reform France's public-hospital sector is known as Hospital 2007. It insists it wants a rationalisation of the hospital system, with funding allocated strictly according to actual treatments delivered. It also wants hospital treatment to be focused in centres of activity that will concentrate specialist staff and equipment to deliver care more efficiently. The Government wants a similar reform of the sickness-benefit system, with benefits granted based on the hospital’s disease codings, rather than subsequent local physician assessments.

The planned rationalisation is due to begin in 2006. The computerised coding system introduced in January will play a key part in deciding future funding for hospitals. It will help healthcare planners allocate the new centres of activity and, as a result, also play a part in deciding hospital closures and staff lay-offs.

The new funding formula within Hospital 2007 is known as T2A, or tarification à l'activité, which will tie funding directly to levels of activity. T2A will depend on the Codage system as its quantitative and severity evidence base.

Critics of the established hospital system claim that the current method of universal funding, known as ‘dotation globale’, has led to a system that puts the interests of staff over those of patients. They point to the bronchitis crisis in 2003 as proof of its failings.

On the eve of the third day of action, Health Minister Jean-François Mattei defended Hospital 2007 in the French cabinet. According to published cabinet minutes, he told colleagues that reform was vital to allow resources to be allocated to patient needs. The T2A funding formula is "an incontestable factor in bringing dynamism and modernisation to the public hospital sector", he said.

Unions claim that the new T2A system has already led to the loss of 900 nursing jobs since January. In a communiqué published just before the March day of action, the unions accuse the government of attempting, "in the name of profits", a multi-speed healthcare service, rationing of treatments, and selection of patients. They also believe the reforms will put managers in charge of deciding treatments, not doctors.

One hospital surgeon, Isabelle Lorand, writing in left-wing newspaper l'Humanité, claimed that the coding system and T2A would establish cost and profit centres in hospitals that would drive the cost of hospital tests up by 30%.

At its annual conference in February, Daniel Moinard, President of the DGCHRU, the association of managing directors of regional and university hospitals, supported Government moves to reform the hospital sector. "The former system was blind, because it didn't take into account the real activity of the establishments", Moinard announced at a press conference. The new system will lead to increased funding, he said, and "greater modernisation and reconstruction of hospitals", although there would be "winners and losers".