France's national disease coding
The first component of France's national health IT programme to go into
service is the health and cost coding system known as 'la Codage'.
Implementation began in January 2004 when it was loaded into patient
management systems in the first 100 of France's 600 plus state-run
The Codage is the cutting edge of the government's Hospital 2007
programme. This is its attempt to rationalise the hospital system with
funding allocated strictly according to actual treatment delivered. As part
of the programme, it wants hospital treatment to be focused into centres of
activity that will concentrate specialist staff and equipment to deliver
hospital care more efficiently.
So the Codage will result not only in shifts in hospital funding, with
many departments receiving less money as a result, it is also intended to
lead to hospital cut-backs and closures.
French hospitals are currently funded under a system known as "dotation
globale" — which is a generalised funding formula. Critics say that this
formula has led to hospitals putting staff interests above those of
Hospital 2007 is replacing this with a new activity-based funding formula
know as Tarification à l'activité, or T2A for short. T2A depends on the
Codage system for its clinical quantitative and severity evidence base.
The rationalisation in hospital activity within Hospital 2007 is
scheduled to begin in 2006, with centralisation of hospital departments into
regional centres and closures of units and hospitals. But unions claim that
Codage and T2A are leading to tens of thousands of nursing job losses.
The government also wants to use the Codage in disability benefits
reform. At present, sickness and disability benefits are awarded according
to a doctor's assessment. The government wants to by-pass doctors, believing
them far too ready to grant disability status. Instead, it wants to use the
Codage system to determine the level of benefits ill and disabled people
All of this has led to fierce resistance from trade unions, opposition
parties and health workers. A common front has been formed, and several days
of action in French hospitals have been held this year.
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