Le document pr\u00e9sente le second volet du rapport d\u2019\u00e9valuation de l\u2019exp\u00e9rimentation \u00ab Incitation \u00e0 une prise en charge partag\u00e9e \u00bb (Ipep), mise en \u0153uvre dans le cadre de l\u2019article 51 de la Loi de financement de la S\u00e9curit\u00e9 sociale pour 2018. Cette exp\u00e9rimentation, lanc\u00e9e en 2017, teste un mode de r\u00e9mun\u00e9ration en soins primaires fond\u00e9 sur la valeur (value-based payment), ciblant des structures ou groupements pluriprofessionnels, en particulier les maisons de sant\u00e9 pluriprofessionnelles (MSP). Le dispositif pr\u00e9voit un int\u00e9ressement collectif pour ces structures lorsque les d\u00e9penses associ\u00e9es aux patients suivis par un m\u00e9decin g\u00e9n\u00e9raliste \u00ab m\u00e9decin traitant \u00bb augmentent moins vite, sous r\u00e9serve du maintien d\u2019une qualit\u00e9 de prise en charge au moins \u00e9quivalente. Les \u00e9conomies r\u00e9alis\u00e9es sont partag\u00e9es entre l\u2019Assurance maladie et les professionnels de sant\u00e9 exp\u00e9rimentateurs.<\/p>\n
L\u2019exp\u00e9rimentation Ipep vise \u00e0 encourager la rationalisation des recours et des parcours de soins, ainsi que la gestion du \u00ab risque \u00bb maladie, en d\u00e9centralisant ces initiatives vers les \u00e9quipes pluriprofessionnelles, consid\u00e9r\u00e9es comme les mieux plac\u00e9es pour identifier les marges d\u2019am\u00e9lioration pertinentes dans leur contexte. Le rapport s\u2019appuie sur des analyses d\u2019impact conduites \u00e0 partir de donn\u00e9es du Syst\u00e8me national des donn\u00e9es de sant\u00e9 (SNDS) et de m\u00e9thodes quasi exp\u00e9rimentales, en comparant des MSP et groupements engag\u00e9s dans Ipep \u00e0 des structures t\u00e9moins, pour diff\u00e9rents sous-\u00e9chantillons de population.<\/p>\n
Les r\u00e9sultats indiquent une \u00e9volution globalement plus favorable des d\u00e9penses de sant\u00e9 pour les patient\u00e8les rattach\u00e9es \u00e0 un m\u00e9decin g\u00e9n\u00e9raliste d\u00e9clar\u00e9 comme \u00ab m\u00e9decin traitant \u00bb dans les structures exp\u00e9rimentatrices, sans qu\u2019un type sp\u00e9cifique de recours aux soins de ville ne se d\u00e9marque comme principal facteur explicatif. L\u2019\u00e9valuation met \u00e9galement en \u00e9vidence des \u00e9volutions diff\u00e9renci\u00e9es sugg\u00e9rant une am\u00e9lioration de certains aspects des parcours et de la qualit\u00e9 des soins, notamment en mati\u00e8re de recours aux services d\u2019urgences non suivi d\u2019hospitalisation, de polym\u00e9dication, de vaccination contre la grippe et de re-contact \u00e0 30 jours apr\u00e8s une hospitalisation.<\/p>\n
L\u2019exp\u00e9rimentation est conduite sous la responsabilit\u00e9 des pouvoirs publics comp\u00e9tents en mati\u00e8re de S\u00e9curit\u00e9 sociale, en lien avec l\u2019Assurance maladie, et s\u2019inscrit dans un ensemble plus large de projets de r\u00e9mun\u00e9rations alternatives \u00e0 l\u2019acte (programme Era2). Le document renvoie notamment \u00e0 deux autres rapports du m\u00eame programme portant sur l\u2019exp\u00e9rimentation \u00ab Paiement en \u00e9quipe de professionnels de sant\u00e9 en ville \u00bb (Peps), \u00e9galement pr\u00e9vue \u00e0 l\u2019article 51 de la LFSS pour 2018. Les \u00e9l\u00e9ments pr\u00e9sent\u00e9s restent soumis aux limites inh\u00e9rentes aux approches quasi exp\u00e9rimentales et aux donn\u00e9es mobilis\u00e9es, et n\u2019identifient pas de modification isol\u00e9e d\u2019un poste pr\u00e9cis de recours aux soins mais plut\u00f4t un ensemble de petites \u00e9volutions convergentes.\u00a0(contenu r\u00e9sum\u00e9 par l’IA)\u200bLire la Suite<\/a>\u200b<\/p>","protected":false},"excerpt":{"rendered":" Le document pr\u00e9sente le second volet du rapport d\u2019\u00e9valuation de l\u2019exp\u00e9rimentation \u00ab Incitation \u00e0 une prise en charge partag\u00e9e \u00bb (Ipep), mise en \u0153uvre dans le cadre de l\u2019article 51 […]<\/p>\n","protected":false},"author":1,"featured_media":4240,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[158,29,4],"tags":[59,227],"class_list":["post-21213","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-assurance-maladie","category-evaluation-des-politiques-sociales-et-sanitaires","category-offre-de-soins-et-hopital","tag-irdes","tag-ia"],"_links":{"self":[{"href":"https:\/\/veilles-affaires-sociales.fr\/index.php?rest_route=\/wp\/v2\/posts\/21213","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/veilles-affaires-sociales.fr\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/veilles-affaires-sociales.fr\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/veilles-affaires-sociales.fr\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/veilles-affaires-sociales.fr\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=21213"}],"version-history":[{"count":0,"href":"https:\/\/veilles-affaires-sociales.fr\/index.php?rest_route=\/wp\/v2\/posts\/21213\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/veilles-affaires-sociales.fr\/index.php?rest_route=\/wp\/v2\/media\/4240"}],"wp:attachment":[{"href":"https:\/\/veilles-affaires-sociales.fr\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=21213"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/veilles-affaires-sociales.fr\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=21213"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/veilles-affaires-sociales.fr\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=21213"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}