Day surgery tariffs in France and in other countries : Current situation and future prospects

Day surgery allows the patient to return home the same day of surgery. This practice highly developed in many European countries and became a large majority of surgery, while it still represents only 40 % of total surgeries in France.

To encourage the development of day surgery, a single tariff between day and conventional surgery was introduced by the French government from 2009. Initially for 18 surgical procedures, its scope has gradually extended to apply to 47 procedures in 2013.

HAS found that the single tariff contributed to the development of day surgery, but the portion attributable to price incentives was hardly measurable. It has also identified several limitations.

HAS then conducted a literature review of the various innovations introduced abroad about tariff and organizational scheme:
   * bundled payment experienced in the United States,
   * best practice tariff  based on the cost of the most efficient practice in Great Britain,
   * use of facilities without accommodation totally dedicated to day surgery (ambulatory surgery centers) and independent legally and administratively, in the United States.

HAS identified eleven topics and developed 25 recommendations presented in summary sheets, offering tracks for improvement:
   * accompanying tariff measures by other types of incentives (investment plan, staff training), whose consistency must be ensured both at national and local level;
   * restoring the tariff neutrality principle;
   * improving the readability of tariff incentives;
   * specifying the objectives of the regulator;
   * modulate the national target rate (50% for day surgery in 2016) per procedure, while promoting the most efficient ones.

HAS also recommends that France experiments new tariff models inspired from the UK and U.S. experiences, in order to improve the efficiency of surgery.