Hello mauricecolina
Let's start with an outline of the reimbursement system before we get
into the rather complex question of tariffs.
In France, most people are entitled to an average reimbursement of 70%
from the Sécurité Sociale (Social Security) when they visit a doctor,
hospital etc. They are responsible for paying the balance, and for
nearly everyone this is done through private health insurance. The
poorest six million people in the country have their health costs
covered in full by the Sécurité Sociale. This is all simplified by a
newish scheme where everyone has a credit-card-sized health ID card
called a "Carte Vitale". Once all doctors are hooked up to this
electronic system, paying for medical tests and treatment will be a
one-swipe business, with a lot of paperwork eliminated.
There are agreements between the professional bodies and the Sécurité
Sociale about what doctors/hospitals can charge for diagnostic tests,
with a separate agreement between laboratories and the Sécurité
Sociale for lab analyses, e.g. blood tests. Patients in France are
free to choose their own doctor/hospital. If they choose one charging
more than the basic cost agreed with the Sécurité Sociale, they will
not be reimbursed 70% of the total, only 70% of the "official" price,
the "tarif conventionnel".
Diagnostic tests carried out by medical staff in both public and
private hospitals are reimbursed at the 70% rate, while laboratory
analyses only attract 60% reimbursement. In both cases the balance
must be found by the patient or his insurer.
The classification and tariff sytem for hospital tests
(non-biomedical) is currently being changed.
However, there is no change relating to laboratory tests which are on
an official list of biomedical procedures called the "Nomenclature des
Actes de Biologie Médicale" or NABM. Since the NABM has full tariff
information available online, unlike the other lists governing other
kinds of diagnostic test, I'll deal with it first and hope that will
help when it comes to looking at how the others work.
==================================================
Nomenclature des Actes de Biologie Médicale (NABM)
==================================================
Each biomedical test is given a code for bureaucratic purposes and
also a coefficient number, sometimes referred to as coefficient B. In
this extract from the NABM list I've marked the coefficient figures
with asterisks.
1115 5 1 *30* 01/01/1996 TEST SOLUBILITE DE L'HEMOGLOBINE
1116 5 1 *50* 01/01/1996 TEST D'AUTO-HEMOLYSE
1117 5 1 *20* 01/01/1996 TEST A L'ISOPROPANOL
What is B? This is the key to working out the going rate for
laboratory tests and analyses. (B for biology) You multiply the number
in the coefficient column by the value currently assigned to key
letter B (lettre-clé B) to determine the monetary cost.
B is currently set at 0.27 Euros.
So the first test on the list would cost 30 times 0.27 Euros = 8.1
Euros, the second would be 50 times 0.27 Euros and so on.
The advantage of this is that it fixes the cost of one test relative
to another, and so the list can stay the same from year to year. An
announcement that key letter B has changed is all that's necessary to
increase charges.
Here's the table with "coefficient B" in column 4:
http://www.ameli.fr/nabm/download/Nabm015.pdf
(please note that the first few items on the table are not tests but
supplementary costs, e.g. for urgent cases at night)
Here's an explanation of all the different columns in the table,
including which tests are only available with prior agreement (entente
préalable) and the few which are always fully reimbursed
(remboursement à 100%), e.g. tests relating to hepatitis C:
http://www.ameli.fr/nabm/download/Note015.pdf
To read these and other pdf documents, you'll need Adobe Acrobat
Reader. If you don't already have it, it's easy to download from:
http://www.adobe.com/products/acrobat/readstep2.html
I don't know if you read French. Please ask if you have a query about
the vocabulary in these documents, so I can help out.
=====================================
Nomenclature des Actes Professionnels
=====================================
The coefficient system is also used for charging for tests in private
hospitals. The relevant list here has the huge title of "Nomenclature
des actes professionnels des médecins, des chirurgiens-dentistes, des
sages-femmes et des auxiliaires médicaux". (NDAP) This covers a range
of medical procedures, not only tests. Key letters are assigned, for
instance KE for ultrasound ("actes d'échographie, de doppler"). The
value for KE is 1.89 Euros as you will see on this tariff:
http://www.ameli.fr/67/DOC/72/article.html
To obtain a copy of the "Nomenclature des actes professionels", write
to one of these addresses:
UCANSS : 33, Avenue du Maine - 75755 Paris Cedex 15
Journal Officiel : 26, rue Desaix - 75732 Paris Cedex 15
The addresses are included in a document where you will find further
helpful information:
"Rapports entre les médecins et les caisses"
http://www.conseil-national.medecin.fr/CNOM/GuideEP.nsf/0/d25149ae3fbdd3cbc12567c100704069?OpenDocument
============================
Catalogue des Actes Médicaux
============================
Public hospitals use a different list, the "Catalogue des actes
médicaux" (CDAM). Instead of a key-letter/coefficient, this has an
index of relative cost, "indice de coût relatif" or ICR.
It is arranged differently from the NDAP with all diagnostic tests
listed in Section A (Champ Alpha):
Catalogue des actes médicaux, champ alpha, actes diagnostiques et
thérapeutiques. Vol. 1
http://alexpub.hospvd.ch/Document.htm&numrec=031093068927580
Catalogue des actes médicaux, champ alpha, actes diagnostiques et
thérapeutiques. Vol. 2, [Présentation par ordre croissant des codes,
indices de coût relatif, liste des modifications]
http://alexpub.hospvd.ch/Document.htm&numrec=031099780927150
The hospital establishes the level of the ICR.
I found an example telling the story of Monsieur Y. During his
hospital stay he had X-rays (examens de radiologie) valued at 6 ICR.
(Index of Relative Cost)
That year the entire activity of the radiology department was
equivalent to 200,000 ICR and 10 million francs, meaning one ICR was
costed at 50 francs.
So Monsieur Y's X-rays came in at 300 francs. (This was in 1994.)
"Combien coûte le séjour de Monsieur Y ?"
http://www.le-pmsi.org/mco/presentation/iii.html
More detailed information on the CDAM and the public hospitals is
included in this document published on the Programme de Médicalisation
des Systèmes d'Information (PMSI) website:
http://www.le-pmsi.org/mco/presentation/ii.html
=========================================
Classification Commune des Actes Médicaux
=========================================
Because of the inconvenience of having two different coding/pricing
systems for medical procedures, and because of various inadequacies in
both systems, the French health system is moving towards a new
classification list, called the "classification commune des actes
médicaux" or CCAM. This will soon replace both the NDAP and CDAM.
The CCAM is divided into chapters (nervous system, eye, ear etc.),
with the diagnostic tests at the start of each chapter. Click the
links for more detail:
http://www.le-pmsi.org/ccamv0b/v0bishtm/
Although there is already plenty of information available about the
CCAM online, it is still not linked to a tariff in coefficients, euros
or anything else.
You could check here from time to time for developments:
http://www.ameli.fr/77/DOC/83/enquete.html
Look out for anything related to "tarification".
===================
Further Information
===================
The French Health Service
http://www.moving-to-france-made-easy.com/french-health-insurance.html
The "Carte Vitale"
http://www.bonjourmagazine.com/articles/images/no19/Carte%20Vitale.pdf
French Health Service is Best
http://society.guardian.co.uk/print/0,3858,4139496-105965,00.html
Outline of reimbursement system from patient's point of view
http://www.ginkgo.tm.fr/explik3.htm
Reimbursement of costs by type
http://www.egide.asso.fr/fr/guide/vivre/soigner/remboursement.jhtml
More on the NABM
http://www.ameli.fr/76/nabm.html?page=download
Agreement between laboratory directors and insurance companies
http://www.sfil.asso.fr/sfil/pages/fr/52.htm
Reimbursement forms
http://www.ameli.fr/formulaire2/S3131.pdf
http://www.ameli.fr/formulaire2/S3132.pdf
More on reimbursement
http://vosdroits.service-public.fr/ARBO/170108-NXSAN105.html
Long report on health and finance:
http://www.sante.gouv.fr/htm/actu/panier/sommaire.htm
I do hope you'll find this helpful. It's quite a challenge untangling
some of the bureaucracy around the French health service!
When you've had a chance to read through the answer and the pages I've
referred to, please ask if there's something I could clarify for you.
If you don't read French easily I realise it could get tough. So much
of the key material is not available in English.
Google's automatic translator offers some rough and ready help:
://www.google.co.uk/language_tools?hl=en
You could try these sites for translation of individual words:
Word Reference
http://wordreference.com/
Travlang (beware pop-up ads here)
http://dictionaries.travlang.com/FrenchEnglish/
As I say, just ask for 'clarification' if you have a query of any
kind, and I'll do my best to help.
Best Wishes - Leli
search terms:
French "health service"
"Sécurité Sociale" remboursement
analyses OR examens laboratoire
testes diagnostiques
tarif convention
tarif "Sécurité Sociale"
tarif hôpital OR hôpitaux
hôpital OR hôpitaux frais
tarif conventionnel
Santé tarification
carte vitale
NDAP
Nomenclature des Actes Professionnels
CDAM
Catalogue des Actes Médicaux
NABM
Nomenclature des Actes de Biologie Médicale
CCAM
Classification Commune des Actes Médicaux
ICR
indice coût relatif
"lettre-clé B" euros
coefficient tarif
searching on google and:
Public-Service.fr (documents related to public services)
http://larecherche.service-public.fr/
Ministry of Health website
http://www.sante.gouv.fr/
When using google I found it best to restrict many searches to French
sites only, for example:
Santé tarification site:.fr
://www.google.co.uk/search?hl=en&ie=UTF-8&oe=UTF-8&q=Sant%C3%A9+tarification+site%3A.fr&btnG=Google+Search&meta= |
