ACTIVITY REPORT. Technical Agency for Information on Hospital Care

Transcription

1 ACTIVITY REPORT Technical Agency for Information on Hospital Care

2 ATIH IN 2016*, YANN ABD-EL-KADER, MOUNIA ABOULOSSOUD, WADII ACHOUR, ANNE ALDEBERT, THOMAS ANDRE, TANTELY ANDRIANOELY-MALIN, MARIE ASTIER, JAMILA BAHRA, ALIRÉZA BANAEI, ANNE BATAILLARD, YASSINE BELHAJ, MARIE-JOSÉ BEN NACEUR, MAX BENSADON, MARLÈNE BERNARD, JEAN-PAUL BLANC, AURÉLIE BORDE, FATIHA BOUALOUAN, NELLY BOULET, SÉBASTIEN BOURDY, FRANÇOISE BOURGOIN, JEAN-CHARLES BUISSON, ANNE BURONFOSSE, LAËTITIA CHOSSEGROS, ÉMILIE CHUNG, RONALD CHUNG, MARIE-CAROLINE CLÉMENT, GAËLLE CONTESTI, OCÉANE CORNIC, ALINE CUSSON, NICOLAS DAPZOL, PHILIPPE DE MEY, JEANINE DEFEVER, ALEXANDRA DELANGLE, ALBANS DEMBLOCQUE, JONATHAN DHIF, YANN DROCOURT, JOËLLE DUBOIS, CHRISTOPHE DUJARDIN, ISABELLE DUSSART, ÉRIC EKONG, CHABI-FABRICE ELEGBEDE, ANIS ELLINI, LISE FRANÇOIS, AURÉLIE GARNIER, CLÉMENT GARRIGOU, FRANÇOIS-XAVIER GIRARD, CHRISTOPHE GUEGAN, OLIVIER GUYE, ABILÉ HAIBOU KOUSSE, MORGAN HAMON, GAËLLE HARMENIL, ISABELLE HERNANDO, MARIE-SOPHIE HERRARD, THANH-AN HOANG, DELPHINE HOCQUETTE, HOUSSEYNI HOLLA, CLARA HURAND, NADINE JACQUEMET, SERGE JALOYAN, STÉPHANIE JOULLIÉ, SAMIR KAIDI, ÉLISE KAYSER, YAMINA KHELOUFI, KATIA LA MELA, ANNE LAVALLARD, CATHERINE LE GOUHIR, CAROLE LÊ-LEPLAT, CLAUDINE LESUEUR, ROBIN LOUVEL, XAVIER MALIN, JULIEN MARANDET, ESTELLE MARIN-LAFLÊCHE, MYRIAM MARTIN, NICOLAS MAYOT, MATHIEU MAZUIR, NICOLE MELIN, AXELLE MENU, MATTHIEU MERCIER, FLORENT MONIER, VINCENT MONOT, CHRISTINE MORCRETTE, MOSSAND, MARC MOUNIER AGNÈS, DAMIEN MURE, DIANE PAILLET, KARINE PALMIERI, FABIENNE PECORARO, STÉPHANE PEQUIGNOT, FLORENCE PINELLI, VINCENT PISETTA, STÉPHANIE POINT, SANDRINE POIRSON-SCHMITT, ROMAN POURCHER, GAËL PRIOL, CHRISTINE PRODOM, THIERRY PROST, FRÉDÉRIC QUICHON, CLÉMENT RALLET, CHARLINE RAPPASSE, CAROLINE REVELIN, THOMAS RICOU, AURÉLIE RIGAUD, NATHALIE RIGOLLOT, GUYLÈNE ROBERT, LYES ROUABAH, MARJOLAINE ROUMANI, MÉRIEM SAÏD, MESSAOUDA SASSI, DOMINIQUE SAUTEREAU, VÉRONIQUE SAUVADET-CHOUVY, BRICE SAUVAJON, OLIVIER SERRE, PADRIG STEUNOU, SANDRA STEUNOU, SOLÈNE TADJ, FATMA TEKRANE, AGNÈS TEUTSCH, EMMANUEL THAMMAVONG, BORNIYA TOUAHRI, LAURENT VOISIN, DIANE WALLET * on 31 December 2016

3 TABLE OF CONTENTS I. Introduction 5 II. Summary of 2016 work 9 III work Modernising institutional funding Supporting regional health agencies 25 agencies in their management of healthcare services 3. Ensuring integrity and secure 27 access of data managed by ATIH 4. Collecting and returning information 30 to improve the knowledge of institutions 5. Positioning ATIH in its environment Optimising the internal performance of ATIH publications 44 IV. Glossary 45

4 EDITORIAL by the Managing Director of ATIH The year 2016 marked the end of a cycle, that of the Objectives and Performance Contract (contrat d objectifs et de performance - COP). During these three years, the Technical Agency for Information on Hospital Care (ATIH) expanded its missions and extended its scope of intervention to the medico-social sector. This expansion was accompanied by a revision of its governance, now based on a board of directors, a steering committee and a scientific council. These three bodies favour the development of the Agency. In 2016, much of the Agency s work was focused on two major areas. First, the funding system for healthcare organisations and medico-social structures, where the levels of maturity vary according to the sectors and activities. The objective is to innovate, using new models such as community hospitals, the creation of new modalities for funding of isolated activities and the integration of quality into the system. This modernisation is carried out in particular through the work performed on the Agency s tools, such as classification or cost measurement. It also contributes to the design of funding models. Furthermore, in 2016, preparatory work for the new funding model for post-acute care and rehabilitation (soins de suite et de réadaptation - SSR) activities began. Thanks to the expansion of costing and performance indicators of medico-social structures, the description of the activity of this sector will be improved and will be able to inform decision makers. Second, the accessibility and visibility of the data collected as a result of the law on modernisation of the French health system affected the dissemination of data. The Agency was able to react and propose operating solutions for secure access for the use of information from the Program for Medicalisation of Information Systems (programme de médicalisation des systèmes d information - PMSI) in accordance with the new legal requirements. However, in addition to access to detailed data, aggregated and relevant information must be available. To this end, the ScanSanté [HealthScan] data retrieval platform has adapted, in particular to changes in the services provided by organisations and territories, facilitating the use of each user. Information sessions in the regions were organised throughout the year to promote its adoption. They will continue in Communication tools were designed to present summarised information, with the development of the Hospitalisation in figures [L hospitalisation en quelques chiffres] mobile app or the breakdown of the Key figures for hospital care [Chiffres clés de l hospitalisation] sheets.

5 3 These topics position ATIH as an essential operator in the collection, restitution and analysis of data from healthcare organisations and medico-social structures. With the next COP , a new period opens for the Agency, ambitious with serious endeavours in the modernisation of the collection mechanisms, while reinforcing the secure access to the data collected. Modernisation of the collection involves in particular implementing the information systems of the organisations to avoid a re-entry of data and to coordinate the different collection mechanisms of the operators to avoid multiple transmissions of the same data. This information will feed reflection for improving and designing funding models in line with the needs, the organisation of healthcare services and the budgetary context. The funding model will be updated for medicine, surgery and obstetrics (médecine chirurgie obstétrique - MCO) and residential care institutions for dependent adults (etablissements d hébergement pour personnes âgées dépendantes - EHPAD), set up in SSR, and designed for hospitalisation at home (hospitalisation à domicile - HAD), psychiatry and structures for the disabled. The Agency must also ensure horizon-scanning of funding models, of indicators of activity, relevance, productivity, quality and performance of care, while drawing on foreign models. In an evolving healthcare system, the Agency must adapt and further optimise its operations to best meet the needs of its audience. The success of this future COP will depend on those who contribute to the overall performance of ATIH and its improvement. Housseyni Holla

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7 5 I. INTRODUCTION Founded in 2000, the Technical Agency for Information on Hospital Care (ATIH), is a public administrative institution overseen by the Ministers for Health and Social Security. The headquarters of the Agency are located in Lyon with a branch based in Paris. The strategic guidelines are dictated by a Board of Directors, a steering committee and a scientific council. The head of the Board of Directors is appointed by the Ministers for Health, Social Affairs and Social Security. ATIH is a centre of expertise in charge of : - collection, hosting, processing and analysis of data from healthcare organisations - technical management of institutional funding mechanisms - conducting costs studies for health and medico-social institutions - development and maintenance of health classifications (nomenclatures).

8 6 Audience State services: General Directorate of Health Services (Direction générale de l offre de soins - DGOS), Social Security Directorate (Direction de la sécurité sociale - DSS), General Directorate of Social Cohesion (Direction générale de la cohésion sociale - DGCS), General Directorate of Research, Studies, Evaluation and Statistics (Direction de la recherche, des études, de l évaluation et des statistiques - Drees), General Directorate of Public Finances (Direction générale des finances publiques - DGFIP), General Inspectorate of Social Affairs (Inspection générale des affaires sociales - IGAS), General Secretariat of the Ministries for Social Affairs, etc. Court of Audit (Cour des comptes) National Health Insurance Regional Health Agencies (Agences régionales de santé - ARS) Hospital federations Healthcare organisations National organisations: Biomedicine Agency (Agence de la biomédecine - ABM), National Support Agency for the Performance of Healthcare Organisations (Agence nationale d appui à la performance des établissements de santé - ANAP), National Management Centre (Centre national de gestion - CNG), National Solidarity Fund for Autonomy (Caisse nationale de solidarité pour l autonomie - CNSA), French National Authority for Health (Haute autorité de santé - HAS), National Cancer Institute (Institut national de lutte contre le cancer - INCA), etc. Teachers, researchers Companies: study and consulting firms, the media, etc.

9 Introduction 7 Internal organisation of the Agency Management External communication ARS mission Data reconstitution mission (ScanSanté) Secretariat general Quality Legal affairs and markets Budget, accounting, management Human Resources management and internal communication Secretariat Responses to outside requests Architecture and IT production Web information system Medical information collection systems Software for healthcare organisations System and network Classifications, medical information and funding models MCO / HAD SSR / Psychiatry Health classifications (nomenclatures) Medical statistics National cost studies Funding and economic analysis Allocation of resources to healthcare organisations Monitoring the National Objective for Health Care Spending (Objectifs nationaux de dépenses d assurance maladie - ONDAM) Analysis of data and performance indicators Staff 6% 5% As of 31 December 2016, the Agency employed 120 employees on a contractual basis and civil servants on secondment or provision. 16% 11% Division of labour within the Agency (management committee not included) 34% Statistician Computer scientist Administrative Physician Comptroller Others 28% Typology Average age: 41 years Gender breakdown: 57.5% women and 42.5% men

10 8 Agency budget The 2016 budget amounted to 28,662, % 31 % Payroll Operating costs Investments Expenditures 66 % 7 % 4 % National Health Insurance Private resources Funds for modernisation of public and private healthcare organisations (Fonds pour la modernisation des établissements de santé publics et privés - FMESPP) National Solidarity Fund for Autonomy (CNSA) Other extraordinary income 49 % Income 32% 8 %

11 9 II. SUMMARY OF WORK IN 2016 In 2016, the Agency advanced and finalised the work included in its COP on modernising institutional funding, supporting the ARS, securing access to data, data collection and restitution, etc.

12 10 Modernising funding of hospitals and social and medico-social services and organisations Inter-field activities Measures on the non-conforming funding model for community hospitals as well as the implementation of the financial incentive to improve quality (incitation financière à la qualité - IFAQ) were applied in 2016 for MCO before deployment in all the fields. Medicine, surgery and obstetrics (MCO) The section was updated by updating the list of associated complications or morbidities. The sliding scale mechanism was applied in an operational manner to the revenues of organisations for 25 categories of activities. To improve funding for critical/emergency care, a specific cost survey was conducted. To refine the measurement of costs, the work on mechanisms for care load measurement was continued and dialysis structures were integrated into the national cost studies (Etudes nationales de coûts - ENC). Post-acute care and rehabilitation (SSR) In the section, the description of the major category of diagnosis Disorders and traumas of the osteo-articular system was refined. For funding, preparatory work was carried out to combine current and future funding modalities in Hospitalisation at home (HAD) In MCO HAD, a study was carried out to characterise the place of HAD in the hospital care field and to analyse the origin of HAD patients. Psychiatry The collection of medical information continues to develop and be refined with a view to the description of the activity. The 2014 data from the psychiatry costs survey were returned. A new survey is under way on the 2015 data. Medico-social - Residential care institutions for dependent adults (EHPAD) The first national cost study, on 2015 data, was conducted. Restitution of the cost framework is expected during the first half of To facilitate data restitution, a categorisation of residents was created. Medico-social Disabled people The work of the first cost survey was launched on a limited sample of 120 structures. Restitution of results is expected in 2017.

13 Summary of 2016 work 11 Supporting regional health agencies (ARS) in their management of healthcare services ATIH continued its methodological contribution to the ARS in the form of work on economic analysis of operations and on tools and methods of annual analysis of operations. To promote the use of hospital restitutions, ATIH organised informational meetings on the operation of the ScanSanté platform in 14 regions. Work on the convergence and consistency of hospital data is still under way, led by the General Secretariat of the Ministries for Social Affairs. Ensuring integrity and secure access of data managed by ATIH Work on the reliability of financial data, consisting of partially supplying the financial data collected by the Agency with those from the General Directorate of Public Finances (DGFIP), was initiated in conjunction with the General Directorate of Health Services (DGOS). Data validation and consistency control tables were adapted to the fields of SSR and psychiatry. Data security resulted in the provision of the Program for Medicalisation of Information Systems (PMSI) databases according to three modalities of access: a secure server hosted by ATIH for institutional users, The Secure Data Access Centre (centre d accès sécurisé aux données - CASD) solution for private service providers, and an ad hoc solution that can be developed by private service providers. The Agency contributed to the work of the National Health Data System (système national des données de santé - SNDS) by participating in the strategic committee, the health data producers committee and the working group on data with low risk of identification.

14 12 Collecting and returning information to improve the knowledge of institutions Collection extended to data related to: activity: redevelopment of the tool for management of reports on activities of general interest (pilotage des rapports d activité d intérêt général - Piramig) costs: implementation of a test on the control and recovery of overcompensation in the framework of institutional funding at the request of the European Commission to assess the difference between the expenses and the revenue from services of general economic interest (SGEI) human resources: continued work on the HR extractor, a data extraction device integrated directly into the HR information systems of the organisations community hospitals: collection of data from Healthcare centres medico-social structures: continued the implementation of the medico-social performance indicators. For the data restitution, the ScanSanté platform has been enriched, in particular with perinatal health indicators. Stakeholders continued to access all of the PMSI databases through a new secure access, benefiting from ATIH s assistance and expertise on these data. As part of the creation of territorial hospital groups (groupements hospitaliers de territoire - GHT), ATIH adapted its data collection and restitution tools on ScanSanté.

15 Summary of 2016 work 13 Positioning ATIH in its environment The Agency has developed new information media such as the Hospitalisation in figures mobile app and the key figures for hospital care sheets, overall and by fields of activity. Some of the Agency s publications have been translated into English to reach new audiences: the 2015 activity report, the Agency s introductory brochure and the national cost studies. This year, ATIH organised several discussions with its partners: information sessions about the specific catalogue of rehabilitation procedures (catalogue spécifique des actes de rééducation et réadaptation - CSARR), meetings on secure access to PMSI data, a conference on the ENC, etc. ATIH participated in the congress on the classification of diseases of the World Health Organisation (WHO) and in Paris Healthcare Week 2017 at the booth of the Ministry of Health. Optimising the internal performance of ATIH One of the new ATIH governing bodies, the scientific council, has deepened its work and launched a call for expressions of interest in the research community on the Agency s field of expertise. The ATIH resource user satisfaction measurement system was redesigned in the form of targeted thematic surveys, to obtain an overall and regular view.

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17 III. WORK IN THE YEAR

18 16 1. Modernising funding of hospitals and social and medico-social services and organisations Health Inter-field activities The two measures below are intended to be applied to all health fields. In 2016, they only involved MCO. Community hospitals The MCO 2016 campaign was marked by the implementation of the non-conforming funding model for community hospitals. This funding model has a two-fold objective: to stabilise the resources of these organisations by giving them visibility and to encourage them to develop their activity. The model is therefore mixed, with a share of the revenue allocated in the form of guaranteed funding (dotation de financement garantie - DFG) and another part allocated according to the activity generated. These new funding modalities only involve services followed by hospitalisation. Outpatient procedures and consultations, services not followed by hospitalisation, missions of general interest and contracting assistance (Missions d intérêt général et d aide à la contractualisation - Migac), annual flat rates and homogeneous rate groups (GHT, rates for HAD activity) are funded under common law. Services followed by hospitalisation are funded via: guaranteed funding, comprised of: - an annual grant corresponding to a fraction (set by decree) of the average revenue for the last two years - an annual organisational and population-based allocation (dotation organisationnelle et populationnelle - DOP) calculated on the basis of the characteristics of the territory (eligibility criteria). Where applicable, a supplemental rate where the DFG is lower than the valuation of the activity by the national rates. This supplement corresponds to the difference between the DFG and the valuation of the activity.

19 2016 work 17 Implementation of the financial incentive to improve quality (IFAQ) The year 2016 was also the year for implementation of the financial incentive to improve quality. After two years of experimentation in volunteering organisations, the model was opened to all healthcare organisations performing MCO activity, subject to being certified by the French National Authority for Health (HAS) with a certain level of certification required and having collected the set of mandatory indicators. For each organisation, based on a set of cross-sectional and specific quality indicators, two scores are calculated: one is equivalent to the quality level achieved and the other reflects the evolution of quality. Organisations are classified into two groups according to the obligation to have the MCO patient record in place. For establishments fulfilling the integration conditions, and for each score, 20% of them are eligible for the allocation. This allocation is calculated based on 3 classes of compensation (breakdown into thirds of the list of eligible organisations): class A: compensation of 0.4% to 0.6% class B: compensation of 0.3% to 0.5% class C: compensation of 0.2% to 0.4%. These credits are allocated based on a specific decree adopted at the end of the year. Medicine, surgery and obstetrics Update of the classification by updating associated complications or morbidities The update of the list of associated complications or morbidities (complications ou morbidités associées - CMA) is based on a methodology validated by all federations. Compared with the 2015 update, the changes were two-fold: a revision of code groups used to define the CMA lists, a revision of the CMA lists based on these new groups. Revision of groups When the CMA were established, codes with an acceptable medical proximity and similar effects on length of stay were grouped together. The objective of the ICD-10 code groups is to reduce the number of parameters to be studied during each review and to increase statistical power when assigning levels. The current groups were created in V11a and have not been reviewed since. Prior to the revision of the CMA effects according to the usual method, the relevance of the groups constituted for V11 was reviewed to integrate the evolution of practices and the increase in available data. Evaluation of relevance is based on two combined consistencies: medical and statistical. Medical consistency is based on the ICD-10 classification categories and the medical proximity of the grouped codes. Statistical relevance consists in grouping together codes with the same level of severity. In case of low numbers, statistics have little meaning and the preference is given to the medical sense. In the end, 25% of groups were modified. In 80% of cases, the modification consisted of a merger of existing groups. In 20% of cases, the modification consisted of a segmentation for a code with a different effect. Sometimes both actions were necessary for the same group.

20 18 Revision of the CMA lists As a reminder, the primary methodological elements are: the CMA effect is the extension of the length of stay (durée de séjour - DS) related to the management, during the same stay, of another condition (comorbidity) other than the one that motivated the stay (main diagnosis) this CMA effect is characterised by a measurement of the average increase in DS in all stays, as well as by the proportion of stays that are extended this effect is studied, for each diagnostic group in ICD-10, over several years, grouping the data into 2-year periods. At the end of the statistical processing, all of the potential developments are medically reviewed and certain choices are made. This method results in: removing from the list codes for which there is no longer any CMA effect re-qualifying the level of severity of codes that no longer have the same CMA effect, (e.g.: CMA going from severity level 3 to level 2, or from level 3 to level 4). updating the list with the codes for which a CMA effect has appeared. At the end, the revision leads to: changing the severity level for 4.75% of diagnoses with a reduction in the number of level 3 diagnoses and an increase in the number of level 2 and 4 diagnoses modifying the severity level for 46,072 stays, i.e. 0.61% of all stays. The movements show an increase in level 1 and 4 stays, and a decrease in level 2 and 3 stays. Implementation of the sliding scale mechanism During the year 2016, the sliding scale measure on the 2015 activity data was implemented in an operational manner. For all 25 roots concerned, a sliding scale is applied to the revenues of organisations showing a change in volume of activity in excess of the thresholds defined by decree. This measure involves applying a reduction of 20% to revenue above the threshold. This implementation necessitated specific discussions with regional stakeholders, in particular to take account of the different possible exclusions in the case of, for example, creation of activities. Reporting of the amount by the ARS was followed by a crossexamination phase, and it was only at the end of this phase that the amounts were applied to the payments. Specific cost survey: critical/emergency care In 2016, ATIH initiated a survey, supplemental to the ENC and accounting reprocessing (retraitement comptable - RTC) collections, to measure the full costs for critical care services (in a broad sense: resuscitation, continuous monitoring and intensive care) and emergency care services, including short-stay hospitalisation units (unités d hospitalisation de courte durée - UHCD) and mobile emergency medical and resuscitation service (service mobile d urgence et de réanimation - SMUR). The survey covers the accounting year It consists of a collection of information on these activities and an analytical breakdown of expenses. Institutions qualified to participate in this type of survey are selected by ATIH following the calls for applications. ATIH selected 49 institutions (41 ex-dg [global allocation - dotation globale] institutions and 8 ex-oqn [national quantified objective - objectif quantifié national] institutions) to participate in the cost survey on 2015 data. Support for all the selected institutions was organised, making a supervisor available. This expert has several roles: to assist the institution in the technical management of the collection tools made available to it by ATIH as well as in the application of the survey methodology, and to carry out an initial verification of the quality of the data sent to the Agency. The critical/emergency care cost survey should be repeated on 2016 data using the same procedures.

21 2016 work 19 National cost studies Implementation of a device to measure care load The request for work on the measurement of care load was expressed during the ENC / RTC steering committee meeting on 18 November The objective is to improve the distribution of healthcare personnel costs in the cost estimation model for MCO stays, according to their relative weights. A working group on this topic was formed. Led by ATIH, it was initially limited to hospital federations in order to agree on the work method, and was then opened up to organisations, whether or not they were participating in the ENC. In 2016, the working group validated the collection methodology based on SIIPS (Nursing care individualised to the person receiving care - Soins infirmiers individualisés à la personne soignée) points and a perimeter left to the discretion of the participating organisations, according to the collections already in place. An evolution of the collection tools is under development and will be operational for 2017 transmissions on 2016 data. The collection will be open, on an optional basis, to institutions participating in the MCO ENC, but also to non-participants who wish to contribute to ATIH s work to improve cost measurement. Inclusion of dialysis To have a cost measurement on all the dialysis care arrangements (inpatient and outpatient), without resorting to an ad hoc survey, ATIH modified the technical and methodological conditions for carrying out the MCO ENC. These changes were carried out in 2016 to make it possible to send 2016 ENC data in All public and private sector dialysis institutions can therefore now participate in the ENC. For this first year of collection, 16 dialysis institutions were included in the MCO ENC sample: 15 ex-oqn and 1 ex-dg. Post-acute care and rehabilitation Improvement of description of major category 08 (CM 08) ATIH undertook review work for CM 08 Disorders and traumas of the osteo-articular system. Evolution of the grouping algorithm for two nosological groups (GN) GN 0803 Amputations, for which certain procedures from the specific catalogue of rehabilitation procedures (CSARR) external limb prosthesis apparatus are involved in the root subdivision of this group. GN 0824 Multiple fractures and associated trauma, for which new conditions for entry into the group are based on the association of a fracture code reported in main morbidity and a separate location fracture code reported in the associated diagnosis position. Evolution of nosological groups After revision of diagnoses for entry into the groups, resulting from medical and statistical analyses based on lengths of stays, CM 08 goes from 21 to 23 nosological groups. Creation of four groups: - GN 0870 Complicated fractures - GN 0873 Severe traumatic spinal injuries - GN 0876 Scoliosis, herniated discs and other back pain - GN 0878 Osteopathies Merger of GN 0830 and GN 0832 to create GN 0872 Fractures of the upper end of the femoral neck (excluding fractures with joint implant)

22 20 Deletion of GN 0865 Malformations and deformations of the osteo-articular system Reorganisation of the entry lists of the other nosological groups (resulting from these creations-deletions or the CM 08 revision work). Review of roots As a result of this revision of the nosological groups, ATIH carried out a revision of the roots of medico-economic groups (groupes médicoéconomiques - GME) of CM08. Preparation of the 2017 funding model combining the current modalities and the future funding mechanism The French Social Security Funding Law (loi de financement de la sécurité sociale - LFSS) 2017 provided details on the implementation of the SSR activity funding model described in the French Social Security Funding Law (LFSS) Thus, the LFSS affirms the need for a gradual implementation of the new mechanism and proposes a new plan leading, for 2017, to the combination of the old funding modalities with the new ones and, for 2018, the funding of the SSR activity according to the target mechanism. The year 2016 allowed ATIH to carry out all of the preparatory technical work. The first half of the year was devoted to the development of the technical valuation parameters of the activity (weighting scales and flat rate zones). These first items were based on the 2011 and 2012 cost data and on the 2014 activity data structured according to the 2016 classification version. At the end of this work, the results were disseminated to all stakeholders, allowing the stakeholders to position themselves in relation to the average, through three indicators reflecting the economic burden in stays, in days and the performance indicator in terms of duration. During the second half of the year, the parameters were refined, taking into account more recent information about costs (integration of 2013 and 2014 data) and about activity. In addition, funding elements related to other sub-funds (Migac, specialised technical facilities, expensive molecules, external activity) could be added for establishments under the annual allocation fund (dotation annuelle de financement - DAF). All of this information made it possible to construct, based on the 2015 budget information, impact simulations of the model integrating as many parameters as possible. This work was presented and distributed to all stakeholders in December The IT tools were updated to integrate the changes in classification, as well as in terms of economic valuation of the activity. Hospitalisation at home First work on the MCO / HAD pathway The positioning of HAD in the care field and the necessary development of this activity were reaffirmed in the 2013 memorandum. Improvement in accessibility to HAD was a serious endeavour, and in particular the development of the HAD prescriptions, of hospital origin in 70% of cases. In 2016, ATIH carried out a study to characterise the place of HAD in the hospital care field and to study the recruitment of patients in HAD. Analyses focused on the national PMSI databases of the fields of HAD, MCO, SSR, and psychiatry. A cohort of patients who received initial care in HAD (index stays) during the year 2014 was identified. The hospital pathway of these patients was recreated by chaining stays (taking into account stays completed in the 6 months preceding the entry into HAD or started within 6 months after the discharge from HAD).

23 2016 work 21 The results of the study led to the following conclusions: today, HAD is very much in a hospital care field. MCO is the primary field of recruitment (care in HAD motivated in particular for monitoring of high-risk pregnancy and post-partum disease, palliative care, complex dressings). This study is a first step. Characterisation of HAD recruitment needs to be further developed: identification, in the case-mix of MCO institutions, of activities that may lead to HAD prescription; recruitment through hospital outpatient services or emergency hospital services. Psychiatry Knowledge base for description of activity As part of its mission to provide technical expertise to State agencies, ATIH has been working since 2010 on the collection of medical information in psychiatry (recueil d information médicale en psychiatrie - Rim-P) for: strengthening of the quality of data collected appropriation and use of these activity data by institutions, ARS and at a national level (development of medico-economic restitutions offering nationally validated indicators ScanSanté platform). ATIH would like to develop additional work to better understand: the decision-making trees used at each stage of management of a patient the care pathway of patients in psychiatry. In this context, ATIH asked the various federations representing psychiatric institutions to identify institutions willing to welcome it for visits, during the course of which it sought to: understand the psychiatric activities benefiting patients treated in healthcare organisations, the decision-making criteria that motivated these treatments, and the most appropriate ways to translate these elements into the Rim-P. obtain feedback on the use of the data collected in the Rim-P as part of the management of the institution s activities and the additional needs in terms of data restitutions in psychiatry. A final report with the main elements resulting from the visits and meeting the objectives pursued by ATIH will be prepared in the first half of It will allow inclusion of the information collected during the visits as part of the ATIH s psychiatry project work. Psychiatry cost survey As part of its technical work in psychiatry in 2016, ATIH conducted in parallel: restitution of data from the survey on the 2014 data continuation of work through a 2 nd survey on the 2015 data. Restitution of data from the 2014 survey After monitoring by a supervisor and analysis of the data by ATIH leaders through a quality control process, data from 75 organisations (62 DAF and 13 OQN) were found to be satisfactory for inclusion in the cost database.

24 22 The data restitution work makes it possible for each organisation participating in the survey: to know the costs per unit of work, by section of analysis and their breakdown by cost item to assess its own costs compared to those of the sampled organisations from the same funding sector cost survey A 2 nd cost survey, on the 2015 data, will be done in the same way, to maintain the dynamics of the participating organisations. The sample includes 84 participating organisations (66 DAF and 18 OQN). This 2 nd survey aims to increase reliability and strengthen the data collected. To this end, 3 areas have been improved: the survey accounting plan, the analytical tree and the control tables. Overall restitution of this survey is expected in spring Medico-social Residential care institutions for dependent adults (EHPAD) 2015 EHPAD ENC: closure of the first campaign Since the 2015 collection year, ATIH has carried out a national cost study in EHPAD. This study is a continuation of the cost surveys carried out on the 2012 and 2013 EHPAD accounting data. The information, sent to ATIH throughout the process, fall under three types: descriptive data of the population received: Pathos activity data (tool for evaluating the technical care needs of the elderly) and Aggir (autonomy, gerontology, iso-resources groups). Transmission of this information = each quarter in 2015 data related to time spent with the resident during a typical week Transmission of this information = each quarter in 2015 accounting data reprocessed from the income statement for the year of collection of activity data Transmission of this information = The EHPAD ENC sample is made up of 77 organisations, including 8 drop-outs and 69 participating. The national framework for the 2015 EHPAD ENC will be available in the late first half of It will present results cross-referencing activity data and accounting data by homogeneous groups of residents.

25 2016 work 23 Description of the methods for constructing groups of residents Further to the 2015 EHPAD ENC campaign, a group of medical experts from the federations and associations representing the sector, ATIH and the National Solidarity Fund for Autonomy (CNSA) defined groups of residents (typology of residents) a priori homogeneous from a medical point of view, in terms of: loss of autonomy: use of Aggir ranks 1 and health status: use of Pathos care profiles, grouped into 33 expertdefined combinations 2. The following rules were applied to constitute the resident groups resulting from the cross-referencing of the combinations of Pathos care profiles (PS) and the Aggir ranks : If the numbers for the combination of Pathos care profiles cross-referenced with Aggir ranks are sufficient for all ranks, then a group is created for each rank (i.e. 12 groups created for the combination); If the numbers for the combination of Pathos care profiles cross-referenced with Aggir ranks are sufficient for ranks 1 and 12/13, but they are insufficient for most other ranks, then three groups are created: one for the crossing of the combination with rank 1, one with rank 12/13 and one with the other ranks (2 to 11); If the numbers for the combination of Pathos care profiles cross-referenced with Aggir ranks are sufficient for rank 1, but they are insufficient for most other ranks, then two groups are created: one for the crossing of the combination with rank 1 and one with the other ranks (2 to 13); If the numbers for the combination of Pathos care profiles cross-referenced with Aggir ranks are insufficient for most of the ranks, then a single group is created for the combination, grouping all of the ranks (no distinction of rank for the combination). The 83 resident groups thus created will be used for the restitution of cost data of the 2015 EHPAD ENC. They may be refined for the following EHPAD ENC. 1. Methodological precision: the 13 Aggir ranks are derived from an ascending hierarchical classification, which made it possible to determine - from the 10 discriminant variables coded - 13 homogeneous groups in terms of loss of autonomy. These ranks are a more detailed level than the iso-resource groups (groupes iso-ressources - Gir), since the Gir were created by aggregating ranks with a similar consumption of resources. 2. Methodological precision: one or more of the Pathos care profiles, identical or different, may be coded for the same resident. It was necessary to group the most frequent and medically relevant combinations into care profile combinations.

26 24 The disabled Work on the Disabled costs survey Beginning in 2016, ATIH launched a first cost survey on the sector of organisations and services for children and adults with disabilities. This survey is a continuation of the work carried out within the framework of the Serafin-PH project (services and institutions: reform to adapt funding to the pathways of people with disabilities). The sample of this first survey is limited to: organisations and services for children and adolescents (for 100 organisations and services) residential care institutions for adults with disabilities (nursing homes, residential care homes) for 20 establishments. The work carried out by ATIH in 2016 in collaboration with the Serafin-PH team had two objectives: to obtain initial knowledge of the costs of services provided by organisations and services with initial results in early 2017, by carrying out a cost survey on 2015 accounting data to contribute to a better assessment of the impact of rate changes that may be foreseen. Concerning the first objective, ATIH proposed an approach that relies on an enhanced support of participants. In effect, each structure is monitored by a supervisor from the start to the end of the survey. This cost survey carried out in 2016 cannot cover all of the organisations and services for children and adults with disabilities.

27 2016 work Supporting regional health agencies in their management of healthcare services Continuing methodological support of ARS Different ARS-ATIH exchanges have been opened or are continuing their work to improve ATIH s response to the needs of the regions. The creation in September of a methodology work group with the ARS should encourage methodological discussions on topical issues. For 2016, the work focuses on the economic analysis of the activity with a focus on optimising documents prepared by ATIH and the data restitution needs expressed by the regions. The discussions resulted in the development of tools and methods for the annual analysis of activity and the sub-annual monitoring of activity. Annual analysis of activity Each year, annual analyses of activity sent by ARS are used to create a regional report expected by Parliament. Following discussions with the working group, the process and content of the annual analysis will change for the 2015 publication. For the content, the following ideas were retained: no longer present funding elements focus analysis on activity data expand to the 4 health fields: MCO, HAD, SSR and psychiatry present background data on the dynamics of population change.

28 26 Sub-annual monitoring of activity This data restitution is refocused on MCO activity to monitor the change in the number of stays and the economic volume from the first six months (M6), and then supplemented over the transmission periods of the MCO PMSI. Work on the appropriateness and content of the implementation in the healthcare organisations data validation tool (Ovalide) of a simplified validation sheet and a regional presentation of information contained in this sheet are being continued in 2016 to facilitate the PMSI data validation work by the ARS. These items are currently in an operational construction phase. They aim to optimise the validation time of the ARS while improving the overall quality of data and its homogenisation among regions. Participating in the definition and distribution of indicators of regional healthcare services ATIH trained the ARS on the use of the ScanSanté hospital data restitution tool. During the year 2016, ATIH conducted 14 trips to the regions to provide one-day informational sessions for volunteer ARS agents using hospital data. Each session had 10 to 50 participants. The navigation principles and all the topics of the ScanSanté data restitution platform are presented (activity data, financial data, etc.) and are demonstrated directly on the platform via Internet access. These information sessions will continue in the first quarter of 2017 and will be extended to national stakeholders. Contributing to convergence and consistency of the data returned The discussions are continuing, in partnership with the General Secretariat of the Ministries for Social Affairs, to optimise the mutual enhancement of the ScanSanté and Diamant tools developed by Ile de France ARS.

29 2016 work Ensuring integrity and secure access of data managed by ATIH Adapting collection tools to hospital information systems Continuing work on the reliability of financial data Contacts were made with the General Directorate of Public Finances (DGFIP), in conjunction with DGOS, to consider a direct supply of some of the financial account information collected under the Ancre platform. Implementation of this connection requires that it be possible to recover accounting data currently managed by DGFIP as the need arises. From the extraction already in place for the Court of Audit, tests were carried out. An experiment on a set of institutions could be carried out during 2017.

30 28 Developing and better documenting data quality controls Development of Ovalide tables in psychiatry and SSR To facilitate control of data transmitted in Rim-P and the SSR PMSI, the existing tests in the Dalia tool used in-house were added to the Ovalide tables, in the quality part. Calculation of scores was integrated into the 2 fields, as well as a table in SSR containing the data that will supply the 2016 annual statistics of the healthcare organisations (statistique annuelle des établissements de santé - SAE) from the PMSI. Strengthening the security of data collection and distribution mechanisms Actions for compliance with the security framework Concerning compliance with the security framework, two actions are under way: a service started at the end of the year, culminating in late January 2017 with the development of an action plan for compliance of the scope of the data source of the National Health Data System (SNDS) with the SNDS security framework a consultation to develop the ATIH global action plan for compliance with the state information systems security policy (programme de sécurité des systèmes d information de l Etat - PSSIE) security framework. In 2016, these constraints were integrated into projects for evolution of the technical architecture (e.g.: Citrix architecture isolated as soon as it was set up at the network and virtualisation level, clauses introduced in the call for tenders for redesigning the network core).

31 2016 work 29 Design of solutions for secure access to PMSI data For dissemination of PMSI data, starting in 2016, the Agency has implemented a secure device for access to these data, replacing the secure downloading device used in 2015 for the dissemination of the 2014 PMSI data. The ATIH solution Developed for institutions (Ministry, national agencies, ARS, healthcare organisations, researchers), it is based on access to data via a secure Internet connection (HTTPS protocol) with a strong system-linked authentication (provided with a single-use password) issued by ATIH-supplied hardware to a specific user. The connection to this virtual machine allows connection to an SAS server, using the SAS-EG software. Only the SAS environment is available in this solution. Traceability is ensured by an audit mechanism (log system) of all the SAS processing performed, as well as by the installation of a computer monitoring mechanism that makes it possible to record all the actions carried out by the user (ObservIT). Data inputs or outputs are allowed without a priori constraint, but can be tracked thanks to the mechanisms put in place. In November 2016, the Citrix architecture was implemented. It offers an ergonomic and functional improvement, facilitating the use of the platform. The Secure Data Access Centre (CASD) solution Intended for private service providers, data is accessed exclusively through equipment supplied by the CASD, incorporating a mechanism for biometric identification of users (fingerprints). The equipment provided allows the user to access data hosted in a virtual machine, hosted and configured by the CASD, integrating a set of software to process them. Once the user is connected to the virtual machine, the user can carry out the desired processing. No traceability is carried out on this processing. Any request for data output must go through a filter that verifies the data and allows it to be copied into the virtual machine or transmitted to the user. A solution developed by service providers Private service providers, who wish to do so, can develop their own secure access, complying with the same level of security as ATIH: strong authentication and traceability of all processing. These solutions must be audited by ATIH and the Ministry. In 2016, only 2 companies chose this solution. Work on the National Health Data System (SNDS) In 2016, ATIH, as a producer of SNDS data, participated in all of the work to set up the SNDS under the auspices of the General Directorate of Research, Studies, Evaluation and Statistics (Drees) from an organisational and technical point of view. The Agency contributed to the development of the security framework applicable to the SNDS, which will be the subject of a Ministerial Decree in early ATIH participated in the early meetings of the SNDS strategic committee, chaired by Drees, and the producers committee chaired by the French National Health Insurance Fund for Salaried Workers (CNAMTS). These bodies were created by Article R I of Decree No of 26 December 2016 on the processing of personal data known as the national health data system. A decree currently being drafted will specify the operation thereof. The low risk technical group, defined by the Law of 26 January, identifies so-called anonymous data and so-called low risk data. The purpose of the working group is to more precisely define the data at low risk of re-identification. For this data, the legal access procedure will be simplified. In particular, the authorisation of the French Data Protection Authority (Commission nationale de l informatique et des libertés - CNIL) will not be required. Access may be granted by the National Health Data Institute (Institut national des données de santé - INDS) under conditions previously validated by the CNIL.

32 30 4. Collecting, returning and analysing information to improve the knowledge of institutions Collecting information Activity data- Preparation of the tool for management of reports on activities of general interest (Piramig) DGOS asked the Agency to redevelop the Piramig platform, previously maintained and hosted by a service company. Piramig is an extranet web-based platform designed to monitor the activity reports of missions of general interest (missions d intérêt général - Mig), to evaluate the implementation of Mig as well as the appropriateness of the allocation given in return. The information is entered by the structures that carry out Mig in the institutions. In late 2016, the Agency set out to initiate the redevelopment of Piramig with the transfer of data from previous years to open the new platform in 2017.

33 2016 work 31 Cost data - Control and recovery of overcompensations In the context of management of rate disputes, the European Commission asked French authorities to set up a system for collection of information on all healthcare organisations, in order to measure cost/revenue disparities for services of general economic interest. The purpose of this mechanism will be to control the level of this disparity and to ensure that it does not exceed a reasonable profit rate. Otherwise, a system for recovery of overcompensations will be put in place. During the year 2016, ATIH was asked to create, with the stakeholders, the grid for collection of this information. A test, managed by the federations, was carried out at volunteering institutions during the third quarter. The feedback should allow the collection system to be made more reliable in Financial, budget and accounting data - Preparing a financial data collection indicators sheet During 2016, in conjunction with the regional stakeholders, a financial indicators sheet was prepared for easy restitution of data related to balances (profit, margin, self-financing capacity, debt and investment). This sheet was created as part of the data collection of the 2017 statement of revenue and expenditure estimates (état des prévisions de recettes et de dépenses - EPRD) - Multi-year global funding plan (plan global de financement pluriannuel - PGFP) so that, from the time of input, institutions can view the impact on key indicators of financial analysis. This sheet is intended to be implemented in all collection campaigns and will also serve as a support for data restitution in ScanSanté. Human resource data HR extractor DGOS wished to set up a system for the automatic extraction of raw information on the human resources of healthcare organisations in order to measure different indicators. In 2013, a first call for tenders was launched by ATIH to carry out the pilot phase in 2014, to assess the feasibility of the project. In 2014, the extractor was developed by Midi Picardie hospital IT (Midi Picardie informatique hospitalière - Mipih) and deployed at about fifty establishments. After this first phase, several anomalies were detected. It was decided to continue the project with Mipih, to carry out corrective and ongoing maintenance of the device, and to increase the number of establishments participating in the project to one hundred. This work was managed in connection with DGOS. A new extraction program was developed and implemented in late Extractions are expected to take place in early 2017 over fiscal years 2013 to Participation of the organisations in this project is governed by an agreement signed between ATIH and the organisation. Care quality and safety data Scope Santé and new indicators including e-satis Nearly three years after its launch, Scope Santé, the French National Authority for Health (HAS) s official website for public information on health care quality, has strongly energised the Agency during the year A new version resulting in a complete overhaul of the website was developed at the beginning of the year, for release in May The objective of this new version was to review the design, ergonomics and presentation in order to improve the readability, comparability and accessibility of information. In December, the 2016 results, including for the first time the satisfaction of patients hospitalised in France, were published on Scope Santé. Approximately 56,000 patients responded to a detailed satisfaction questionnaire, resulting in a per-institution satisfaction score. In partnership with HAS, the dissemination of this data on Scope Santé was made possible by the Agency s development, hosting, operation and maintenance of several data collection platforms: E-satis: the platform allows institutions to file s from their patients and allows patients to respond to the satisfaction questionnaire. The Agency also manages the data and participates in the calculation of satisfaction indicators. Qualhas and Bilanlin: platforms for reporting quality indicators of healthcare organisations. Collection of innovative services not classified for reimbursement Following publication by DGOS of a new framework for innovative services not classified for reimbursement, a new version of the Fichsup files has been put online, limiting the entry to the services classified for reimbursement only.

34 32 Community care data - Healthcare centres As part of the national agreement between the healthcare centres and the National Health Insurance to receive payment of the specific fixed compensation provided, each health centre must declare that it has complied with the indicators giving entitlement to compensation. A web-based extranet data collection platform was developed by the Agency to enable health centres to make this declaration and to enter general information about their activity. Following numerous meetings with the DGOS and CNAMTS project managers and tests carried out by volunteering health centres, the platform was opened in late December Health centres must complete and validate their data no later than 28 February 2017; the data will then be sent to CNAMTS for calculation of the compensation. The Agency provides hosting, operation and maintenance of the platform as well as data management. Medico-social data - Performance indicators In the dynamic of scalability of the project, the campaign on the 2015 data was put online in May 2016 for more than 20,000 social and medico-social services and institutions and management organisations. This was an increase of about 80% compared with the previous year s campaign. All regions participated, except for Martinique and the former Auvergne and Picardy regions, which will join the device in Once again, the Agency was heavily involved in this project in 2016 and is responsible for hosting, operation, development and maintenance of the platform, as well as data management. Returning data ScanSanté hospital data restitution platform As a result of collaborative work between ATIH, the French Federation of Perinatal Health Networks (Fédération française des réseaux de santé en périnatalité - FFRSP) and the DREES, a new ScanSanté Perinatal Health Indicators data restitution responds to a request from the DGOS. Its objective is to standardise the methods for calculating perinatal health indicators at a national level. It is accessible to all audiences and provides 12 indicators classified into 2 categories: indicators on deliveries and births, indicators on stillbirths, neonatal and perinatal mortality at hospitals. Secure access to PMSI data ATIH has made the PMSI databases of the 4 fields from 2009 to 2015 available online, with all framework at its disposal as well as all the PMSI nomenclatures. This solution had registered 420 users by late December, half of them in healthcare organisations. In addition, ATIH distributed the databases of the 4 fields from 2009 to 2015 to the CASD and to 2 companies with their own secure access. Users access the data according to their CNIL authorisation. In total, 24 companies worked with the CASD, representing about 80 users. The files resulting from the processing of the cancer algorithm were put online for all users, regardless of the solution.

35 2016 work 33 Adapting collection and restitution tools to territorial hospital groups (GHT) Facilitating the use of the Agency s tools in GHT A user guide for the ScanSanté platform was published online in July Intended for institutions, it should allow them to quickly obtain useful indications for the creation and monitoring of GHT, in particular in terms of activity data. This guide brings together in one document the existing restitutions that were until now disseminated within the platform. This guide identifies and describes applications useful in a GHT context for: creating an overview of the GHT breaking down the contribution of each institution within the GHT infra-annual monitoring of the GHT. ScanSanté data restitutions are also being adapted to a GHT context, including the possibility of selecting groups of institutions. This adaptation makes it possible to compile the results of GHT institutions as if they were a single entity. It is already available for three applications: activity analysis (case mix of institutions), MCO activity analysis indicators and Hospidiag. This adaptation will continue in 2017 for all available data restitutions. Supporting stakeholders in data entry Outsourced technical support Technical support received now has a wider range and a dedicated service provider. These measures were taken after various work such as the implementation of medical-social performance indicators, of secure access to PMSI data, of user satisfaction surveys, etc.

36 34 Analyses and studies Integrating the impact of LFSS measures into tracking of expenditures of the National Objective for Health Care Spending (Ondam): geographical definition of stay, community hospital services, etc. Several measures concerning the funding of health institutions were implemented in The two main ones involved new funding modalities for community hospitals through community hospital service and the new definition of stay (admission and discharge within a geographical structure). As part of the economic monitoring of health care spending, ATIH had to integrate these two measures with major impacts. In particular, it was necessary to adjust the extrapolation methods in order to integrate these new modalities into the annual expenditure estimate based on data from the first six months of activity.

37 2016 work Positioning ATIH in its environment Information media Hospitalisation in figures mobile app After The official rates of hospital activity (L officiel des tarifs de l activité hospitalière), ATIH published a 2 nd mobile app focused on the data restitution for the annual activity of healthcare organisations. This app makes it possible to obtain, overall or by activity, the number of patients hospitalised, place of care and reasons for hospitalisation for each activity: MCO, HAD, SSR and psychiatry. L'HOSPITALISATION EN QUELQUES CHIFFRES

38 Données issues du PMSI 2015, chiffres arrondis au millier près Données issues du PMSI HAD 2015, chiffres arrondis au millier près Données issues du PMSI MCO 2015, chiffres arrondis au millier près Données issues du PMSI SSR 2015, chiffres arrondis au millier près Données issues du Rim-P 2015, chiffres arrondis au millier près 36 Update of the key figures for hospital care From the data collected in the PMSI, ATIH publishes key figures for hospital care, updated each year. There are 5 sheets available: overall and by hospital activities: MCO, HAD, SSR and psychiatry. Using composite indicators, these key figures provide a measure of the number of patients visiting the hospital. Some examples of treatments are detailed PSYCHIATRIE patients hospitalisés en psychiatrie soit 6 pour habitants enfants de - 18 ans soit 3 pour enfants de - 18 ans adultes de 18 à 79 ans soit 8 pour personnes de 18 à 79 ans millions de patients hospitalisés en MCO soit 183 pour habitants MÉDECINE, CHIRURGIE, OBSTÉTRIQUE 2 millions d'enfants de - 18 ans, dont naissances soit 134 pour enfants de - 18 ans 8,6 millions d'adultes de 18 à 79 ans soit 182 pour personnes de 18 à 79 ans 1,5 million d'adultes de 80 ans ou + soit 406 pour personnes de 80 ans ou structures psychiatriques en France dont 63% avec une activité exclusive de psychiatrie Prises en charge à temps complet patients pris en charge à temps complet adultes de 80 ans ou + soit 5 pour personnes de 80 ans ou + 46% publiques sous dotation annuelle de financement (DAF) 31% privées commerciales sous objectif quantifié national (OQN) 23% privées d'intérêt collectif sous DAF ou OQN patients hospitalisés patients hospitalisés patients hospitalisés dont hospitalisation à temps plein patients pris en charge à temps plein % d établissements publics 6,9 millions de patients hospitalisés > patients dans les établissements sous DAF > patients dans les établissements sous OQN > patients dans les établissements sous DAF > patients dans les établissements sous OQN 12,5 millions de patients hospitalisés en France soit 190 pour habitants établissements de santé 2 millions d'enfants de - 18 ans soit 137 pour enfants de - 18 ans 1,6 million de 80 ans ou + soit 419 pour personnes 80 ans ou + 7,1 millions de patients 5,3 millions de patients hospitalisés dans le public hospitalisés dans le privé commercial accouchements dont 1,7% d accouchements multiples décès à l hôpital soit 60% des décès en France (source Insee), dont mort-nés 1,5 million de patients hospitalisés dans le privé d intérêt collectif établissements de MCO en France Financement des établissements 35% d établissements privés commerciaux 32% établissements privés d intérêt collectif Tarification à l activité (T2A) établissements 11,7 millions de patients pour des séjours 0,5 million de patients pour des séances Dotation annuelle de financement 5 millions de patients hospitalisés 1,1 million de patients hospitalisés 17,8 millions de séjours 12,2 millions de séances/forfaits 20 millions de journées de présence à temps complet > 15,2 millions de journées dans les établissements sous DAF > 4,8 millions de journées dans les établissements sous OQN 57,7 journées en moyenne par patient à temps complet 18,4 millions de journées de présence à temps plein >13,7 millions de journées dans les établissements sous DAF > 4,7 millions de journées dans les établissements sous OQN 55,7 journées en moyenne par patient à temps plein 164 établissements patients séjours (dont 98% en médecine) et 400 séances Médecine, chirurgie, obstétrique et odontologie (MCO) Séances 12 millions de patients 16% d'enfants de - 18 ans 12% de 80 ans ou + 7,5 millions de patients pris en charge en hospitalisation complète 10,9 millions de séjours en hospitalisation complète (hors ambulatoire et séances) 5,6 jours d hospitalisation complète en moyenne pour un séjour 5,7 millions de patients hospitalisés en ambulatoire (hors séances) Patients venus pour des séances en chimiothérapie en radiothérapie en dialyse en centre en dialyse hors centre «autres» 4,8 millions de patients en chirurgie dont 46,7% de patients en chirurgie ambulatoire Quelques exemples de prises en charge 3,5 millions de patients hospitalisés parmi les 13,4 millions de patients pris en charge aux urgences patients en réanimation, soins intensifs ou surveillance continue 1,4 million de patients hospitalisés pour endoscopie patients opérés d une cataracte patients opérés pour une prothèse totale de hanche 1,3 million de patients hospitalisés pour une pathologie cardio-vasculaire dont pour infarctus du myocarde IVG réalisées en établissement dont 5% pour des femmes de moins de 18 ans patients pris en charge pour un AVC 1,2 million de patients hospitalisés atteints d un cancer : nombre de patients distincts ayant été repérés par l algorithme cancer de l Institut national du cancer (Inca) patients pour soins palliatifs SOINS DE SUITE ET DE RÉADAPTATION 2015 HOSPITALISATION À DOMICILE patients hospitalisés en établissements de santé de soins de suite et de réadaptation (SSR) soit 15 pour 1000 habitants enfants de - 18 ans soit 2 pour enfants de - 18 ans adultes de 18 à 79 ans soit 12 pour personnes de 18 à 79 ans adultes de 80 ans ou + soit 102 pour personnes de 80 ans ou + 46 % en secteur public patients hospitalisés établissements de SSR 29 % en secteur privé commercial 25 % en secteur privé d intérêt collectif patients hospitalisés patients hospitalisés patients hospitalisés en HAD soit 1,6 pour habitants enfants de - 18 ans soit 0,5 pour enfants de - 18 ans adultes de 18 à 79 ans soit 1,5 pour personnes de 18 à 79 ans Activité des établissements adultes de 80 ans ou + soit 7,1 pour personnes de 80 ans ou établissements exercent uniquement une activité de SSR 806 établissements de SSR exercent une activité mixte dont 96 % de médecine, chirurgie, obstétrique 308 établissements d'had en France 126 publics 55 privés commerciaux 127 privés d intérêt collectif patients hospitalisés patients hospitalisés patients hospitalisés 19 % d établissements publics 43 % d établissements privés commerciaux 38 % d établissements privés d intérêt collectif Structuration de l activité 72 % d établissements publics 15,5 % d établissements privés commerciaux 12,5 % d établissements privés d intérêt collectif Mentions spécialisées les plus courantes Autorisations d exercice Activité des établissements d'had 152 établissements exercent uniquement une activité d HAD 2 % des établissements publics 73 % des établissements privés commerciaux 87 % des établissements privés d intérêt collectif 151 établissements ont une activité mixte d HAD et de MCO 98 % des établissements publics 25 % des établissements privés commerciaux 11 % des établissements privés d intérêt collectif 31 % des établissements détiennent au moins la mention affections de la personne âgée polypathologique, dépendante ou à risque de dépendance 24 % des établissements détiennent au moins la mention affections de l appareil locomoteur 22 % des établissements détiennent au moins la mention affections du système nerveux 88 % des établissements bénéficient uniquement d une autorisation pour adultes 9 % des établissements bénéficient d une autorisation pour adultes et enfants de - 18 ans 3 % des établissements bénéficient uniquement d une autorisation pour enfants de - 18 ans 5 établissements ont une activité mixte d HAD et de SSR Répartition des journées selon les statuts juridiques des établissements d'had 4,6 millions de journées 28,5 jours d hospitalisation en moyenne pour un séjour terminé 1,2 million de journées dans le public 0,7 million de journées dans le privé commercial 2,7 millions de journées dans le privé d intérêt collectif