The Implementation and Pitfalls of Health Care Spending Targets in France

In France a National Objective for Health Insurance Spending (ONDAM) is annually voted by the Parliament since 1996 and is divided into four sub-groups corresponding to a category of care. We describe how the initial diversity in providers' payment rules conduced to particular regulation procedures for each of them. We then show how the failure of this initial regulating model forced the Health Authorities to converge on a single price regulation procedure since 2000. Preoccupation of the French Health Authorities is now to identify spontaneous determinants of health care expenditures growth rate and to adjust resources to the ONDAM level.