Cost of complex abdominal wall reconstruction with biological prostheses in a French public hospital.

GOAL: Retrospective analysis of bioprosthetic abdominal wall reconstruction in our center with regard to expenses and reimbursement. PATIENTS AND METHODS: This study included all patients undergoing bioprosthetic abdominal wall reconstruction between 2009 and 2015. All costs were considered in determining the hospital expenditures. Next we compared the incoming revenue for each hospital stay based on disease-related groups (DRG) and additional daily hospital fees. RESULTS: Seventy-six patients underwent abdominal wall reconstruction, 67 of whom had economical data that were exploitable. On the average, our center lost €15,233 for every hospital stay associated with bioprosthetic abdominal wall reconstruction. The existing DRG system is not well adapted to provide adequate reimbursement for costs related to complex abdominal wall repairs, especially when post-operative morbidity leads to prolonged hospital stay and increased expenses. CONCLUSION: Abdominal wall repairs with bioprostheses are expensive and are poorly reimbursed in the French Health care system, mainly because they are often associated with complications that increase the costs considerably. In our opinion, it seems necessary that either reimbursement of this type of prosthesis should be higher than the current DRG allows, or that the DRG classification be redefined, or even, that a specific DRG be created for complex abdominal wall reconstruction.

[Families is transformation: a Polynesian case (Maatea, Moorea, Society Islands)]. / Familles en transformation: un cas polynesien (Maatea, Moorea, iles de la Societe).

"Using a survey of a set of households in a village community in Moorea (Society Islands, French Polynesia), the author examines family transformations using a 'substantive' approach. Analysis of the resources of each household in the context of the recent opening up to the consumer society gives information on the evolution of incomes, the subsistence level, the building up of surpluses and the degree of 'equipment'. Analysis of the social form of households reveals the multiplicity of family types and variable cycles of transformation from one type to another. This information, which cuts across the social form and mode of management of the households, leads the author to identify five distinct types of household, each with a coherent model of operation. Far from observing a uniform evolution of the extended family towards the nuclear family, the author shows that the opposite evolution is just as possible. The plural, fluctuating nature of the family institution in Polynesia today is noted above all." (SUMMARY IN ENG)