This result demonstrates that the Japanese surgical reimbursement scales still fail to reflect resource utilization despite the revision of surgical fee schedule.

Purpose The purpose of this paper is to examine from the viewpoint of resource utilization the Japanese surgical payment system which was revised in April 2016. Design/methodology/approach The authors collected data from surgical records in the Teikyo University electronic medical record system from April 1 till September 30, 2016. The authors defined the decision-making unit as a surgeon with the highest academic rank in the surgery. Inputs were defined as the number of medical doctors who assisted surgery, and the time of operation from skin incision to closure. An output was defined as the surgical fee. The authors calculated each surgeon’s efficiency score using output-oriented Charnes–Cooper–Rhodes model of data envelopment analysis. The authors compared the efficiency scores of each surgical specialty using the Kruskal–Wallis and the Steel method. Findings The authors analyzed 2,558 surgical procedures performed by 109 surgeons. The difference in efficiency scores was significant (p = 0.000). The efficiency score of neurosurgery was significantly greater than obstetrics and gynecology, general surgery, orthopedics, emergency surgery, urology, otolaryngology and plastic surgery (p<0.05). Originality/value The authors demonstrated that the surgeons’ efficiency was significantly different among their specialties. This suggests that the Japanese surgical reimbursement scales fail to reflect resource utilization despite the revision in 2016.

This knowledge can be generally applied in situations at hospitals with regular PACU use when there are such large disruptions to PACU capacity that it is known before a case begins that the anesthesiologist likely will need to recover the patient (i.e., when there will not be an available PACU bed and/or nurse). The Japanese anesthesiologists have no PACU labour costs but likely greater anesthesia drug/monitor costs.

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The goal of this study is to evaluate the pure impact of the revision of surgical fee schedule on surgeons' productivity. We collected data from the surgical procedures performed by the surgeons working in Teikyo University Hospital from 1 April through 30 September in 2013-2016. We employed non-radial and non-oriented Malmquist model. We defined the decision-making unit as a surgeon with the highest academic rank in surgery. Inputs were defined as (1) the number of doctors who assisted surgery and (2) the time of surgical operation. The output was defined as the surgical fee for each surgery. We focused on the revisions in 2014 and 2016. We first calculated each surgeon's natural logarithms of the changes in productivity, technique and efficiency in 2013-2014, in 2014-2015 and in 2015-2016. Then, we subtracted the changes in 2014-2015 from the changes in 2013-2014 and in 2015-2016. We analyzed 62 surgeons who performed 7602 surgical procedures. The productivity changes were not significantly different from 0. Their efficiency change was significantly greater than 0, while their technical change was smaller than 0 in revision 2014. Their efficiency change was significantly smaller than 0, while their technical change was greater than 0 in revision 2016 (p < 0.05). This finding suggests that we could increase overall productivity through revision if we could increase both efficiency and technique.