Health Insurance Perspective and Collective Perspective: The Differences In The Collection and Valuation of Cost Data In France

Abstract

In France, the French National Authority for Health (HAS) considers two perspectives in economic evaluations, the health insurance perspective to estimate the costs incurred by health insurance, and the collective perspective (all payers) to estimate costs incurred by the entire society. The objective is to present an inventory of available data to collect and value cost data, according to the perspective chosen (health insurance or collective). Cost items most frequently found in economic evaluations include: treatment of interest, treatment administration, medical examinations, consultations, hospital admissions, medical transportation and adverse effects management. For each of these items, review of the data available for the cost valuation in France, according to the health insurance perspective and the collective perspective, was carried out. According to the perspective adopted, the use of available data for cost valuation is variable. In terms of health insurance perspective, cost valuation is based on health insurance rates and reimbursement rates. In a collective perspective, costing raises questions about the quality of the available data as well as their representativeness for the pathology studied, which creates uncertainty about the estimation of costs. This is the case when estimating the costs of hospitalization in the private sector from the national cost study (ENC), in very few hospitals participates (26 in 2015). This is also the case when estimating cost of medical consultations including extra fees, based on aggregated data at a national level by specialty, introducing uncertainty as to the representativeness with respect to the pathology studied. The valuation of costs in health insurance perspective is based on an official nomenclature and that is why it is easier than the valuation in a collective perspective whose data available for certain cost items can introduce uncertainty.