BackgroundIn Japan, there have been approximately 50 000 deaths from gastric cancer annually for over 40 years with little variation. It has been reported that most gastric cancers in Japan are caused by Helicobacter pylori infection. H. pylori eradication therapy was approved for patients with chronic gastritis by the Japanese national health insurance scheme in February 2013 for patients with an endoscopic diagnosis of chronic gastritis is positive for H. pylori. We examined the effect on gastric cancer death rate 4 years after expansion of health insurance coverage.AimWe conducted an epidemiological study and analyzed trends in prescription for H. pylori eradication therapy. We used the electronic medical claims database from Hokkaido, Japan to evaluate the impact of expansion of national health insurance coverage for H. pylori eradication therapy on deaths from gastric cancer.MethodsData on deaths from gastric cancer were obtained from the Japanese Ministry of Health, Labour and Welfare and the Cancer Statistics in Japan (2015). Analysis of electronic claims records was performed using the National Database, mainly focusing on Hokkaido. Prescriptions for H. pylori eradication therapy and the number of patients treated for gastric cancer were also extracted from the Hokkaido database.ResultsApproximately 1.5 million prescriptions for H. pylori eradication therapy were written annually. Gastric cancer deaths fell each year: 48 427 in 2013, 47 903 in 2014, 46 659 in 2015, and 45 509 in 2016, showing a significant decrease after expansion of insurance coverage for H. pylori eradication therapy (P<.0001).ConclusionsPrescriptions for H. pylori eradication therapy increased markedly after approval of the gastritis indication by the national health insurance scheme and was associated with a significant decrease in gastric cancer deaths.

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This study demonstrated that hospital volume influences the clinical outcome in both patients with mild and those with severe acute pancreatitis.

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The Japanese government has introduced the casemix system for the acute-care hospitals since 2003. The applied casemix system is DPC (Diagnostic Procedures Combination) that was newly developed in Japan. The basic idea of DPC is to classify a patient by the combination of diagnosis and procedures conducted within the hospitalization. The first key of classification is diagnosis, and then types of procedures are considered to decide a particular group. One of the main purposes of DPC project is to implement a standardized dataset of in-patient acute care. The keywords are transparency and accountability. Using this framework, we can evaluate the process of medical services. The DPC project collects the three types of information: Form 1 is a clinical summary that contains information on diagnosis and severity. E file has information of the bundled charge of procedure and F-file indicates the detail of bundled procedures. Form 1, E-file and F-file are matched according to the ID number that is unique for each discharged case. Using these data, we can describe the process of each in-patient treatment. As the DPC scheme covers more than 8 million of acute in-patients cases in Japan, it has become one of the important sources of information for clinical analyses, such as patterns of pharmaceutical use and interventional treatments. Furthermore, DPC database can be used for a large-scale multi-center post-marketing clinical study. It is expected that more epidemiologists would have much interest for use of DPC data for studies of clinical epidemiology and health service researches.

This study demonstrated that hospital volume was significantly associated with compliance with CPGs and that the Japanese administrative database was a viable tool for the monitoring of compliance with CPGs.

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In order to ameliorate the transparency of acute in-patient services in Japan, we have developed the Japanese original casemix system, so called DPC (Diagnosis Procedure Combination) after the two years' intensive researches of other countries. This casemix system has been used for payment of acute care hospital since 2003. As the DPC system has been organized based on the already existed Fee-for-service system, its application for payment has been smoothly conducted. The introduction of DPC system has ameliorated the transparency of clinical activities and facilitated the managerial innovation of acute care hospital both at facility level and regional level. In this article, the authors would like to introduce the overview of Japanese casemix system.