La r??forme de la m??decine l??gale (2011) a permis le d??veloppement d???unit??s m??dicojudicaires (UMJ) d??di??es ?? l???accueil sp??cialis?? pluridisciplinaire des victimes d???infractions p??nales. Si le minist??re de la Justice assure le financement des actes ?? finalit?? judiciaire au moyen d???une dotation budg??taire annuelle, les ??tablissements de sant?? supportent le financement du volet m??dico-psycho-social. L???objectif de cette ??tude a ??t?? de d??terminer les co??ts directs de la prise en charge initiale d???une victime de viol afin de voir comment son financement pourrait ??tre repens?? dans le but de limiter les d??penses suppl??mentaires que pourrait g??n??rer une prise en charge insuffisante.

Il s???agissait de chiffrer les co??ts directs sur la base d???une prise en charge compl??te de victime de viol r??cent (<48heures), de sexe f??minin, en tenant compte des charges financi??res en personnels et en consommables, des actes m??dicotechniques, des traitements d??livr??s, des analyses biologiques et des frais dits annexes.

Le temps total estim?? pour une prise en charge compl??te est de trois heures pour un co??t moyen maximal de 673,92???, dont 41,5??% (279,90???) sont financ??s par le minist??re de la Justice. Le versant m??dico-psycho-social ?? la charge des ??tablissements de sant?? repr??sente le poste de d??pense majeur (394,02???) avec une part importante imputable aux examens biologiques de d??pistage des infections sexuellement transmissibles (243???).

Ces situations fr??quentes requi??rent une mobilisation de moyens humains et mat??riels, dont la charge financi??re est r??partie entre le minist??re de la Justice et les ??tablissements de sant??. Les auteurs sugg??rent que, dans la dotation budg??taire annuelle hospitali??re allou??e par le minist??re de la Justice, la prise en charge des victimes de violences sexuelles soit bas??e sur le tarif d???une hospitalisation de jour ????m??decine, sp??cialit??s m??dicales temps incomplet de jour ou de nuit r??gime commun???? afin de pouvoir offrir une prise en charge pluridisciplinaire optimale de nature ?? diminuer les risques de complications et donc de r??duire le co??t global engendr?? par ces situations. Aussi, cette premi??re ??valuation pourra servir de base de r??flexion pour la cr??ation d???UMJ, mais ??galement pour l?????valuation des structures d??j?? cr????es.

The Forensic medicine reform in 2011??enabled the development of forensic units specialized in multidisciplinary care of victims of criminal offences. Thanks to an annual budgetary allocation, the Ministry of Justice handles the financing of judicial acts, while the health care facilities assume the medical, psychological and social aspects. The objective of this study was to determine the direct costs of medical care provided to rape victims (such as defined in the article 222-23??of the Penal Code) in order to see how its funding could be reconsidered to prevent any additional cost that could be caused by non-sufficient medical, psychological and social care. Furthermore, this first assessment may serve as a basis for further reflection on creating other medical judicial units but also for reviewing existing structures.

The direct costs for medical care of a recent rape victim (<48hours) was quantified by including staff and consumables costs, treatments, biological tests and other expenses.

The overall time for the entire medical care procedure was approximately three hours, for an overall cost of 673.92???, of which 41.5??% (279.90???) was paid by the Ministry of Justice. The medical, psychological and social aspects stood for the major expenditure items (394.02???), attributable mainly to the biological screening tests for sexually transmissible infections (STIs).

These frequent situations require the convergence of human and material needs with a financial burden shared between the Ministry of Justice and health establishments. Authors suggest that in the annual hospital budgetary allocation allotted by the Ministry of Justice, the care of victims of sexual assault be based on the rate of day hospitalization ???Medicine, medical specialties part time day or night common regime???, allowing to provide optimal multidisciplinary care, which lessens the risks of complications and reduces the global cost created by these situations.