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the establishment of a new fiscal regime: the state of estimates of revenue and expenditure (SPIE). Under the previous regime, the implementation of the budget for one year was assessed the following year, allowing hospitals to exceed the budget that had been granted. Estimating and sanctionnanten upstream the risk of budget overruns, the SPIE made avail a financial logic in the management of hospitals. Now it is no longer their activity that determines how (and therefore costs) which are necessary, but the recipes they have that affect spending, investment … and therefore their activity.
the implementation of a new method of funding: Pricing in the activity (or T2A). Until 2004, the budget of public hospitals was made for three-quarters of a block grant allocated by the Ministry of Health, and whatever the volume, nature and evolution of their business. Pricing in actiity (or T2A) is now to fund hospitals on the basis of their actual activity. Every act, every practice, every type of care is a price: the public hospital funding now depends on the number of procedures performed and the rate of the latter. The pricing activity (T2A) is a reform whose objective was to end the current hospital funding. Whatever their activity, their evolution, their dynamism or inertia, the overall staffing of hospitals had a tendency to remain unchanged.
These important reforms profoundly affect the activity and the internal organization of public hospitals. Their uniqueness comes from the conjunction and the brevity of the period of implementation.