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 hospitals.

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 patients.

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 receive.

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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