their average size is relatively small panel d and the number of small hospitals is high despite their relatively lower efficiency and fewer innovative practices gobillon and milcent and according to oecd evidence the average costs of some surgical acts are higher than in other european countries koechlin et al as in many other oecd countries oecd c and in line with oecd recommendations oecd a diagnosisrelated group drg payment scheme was phased in during replacing the previous system of global grants and daily allowances it is complemented by volumebased payments such as fees for emergency services or the use of innovative treatments and addon payments such as investments for teaching research and innovation the maintenance of emergency units prevention and treating risky and lowincome patients