The Mirage of Bundled Payment for Care in France

The reference to the Swedish and American experiences to try to convince that the model of bundled payment per episode of care is effective is a fairly risky bet as the analysis of the results obtained in these two countries is devastating for the model. Concerning France, the country does not meet any of the key success factors for implementing bundled payment per episode of care, including the extensive digitization of health, the presence of widely used and consensual quality indicators and a good city-hospital coordination. In addition to the problems inherent in the bundled payment model, its implementation in France is therefore a pipe dream. The two years of endless discussions and meetings without having yet resulted in an applicable plan for this mode of payment illustrate that our health system is not ready for such an experience. When we observe that once implemented, this model has much more perverse effects than economic and medical benefits, the issue of the relevance of the approach arises.