Equality of surgical fee schedule in Japan: a retrospective observational study

Abstract

Background The purpose of this study is to examine how the degree of inequality of Japanese surgical fee schedule changed during the study period by applying Gini coefficients for efficiency scores computed from data envelopment analysis. Methods All the surgeries that were performed in the main operating rooms of Teikyo University Hospital in 2013-18 were candidates used for the analysis of efficiency and equality of fee schedule. The decision making unit was defined as a surgeon with the highest academic rank in the surgery. Inputs were defined as (1) the number of assistants, and (2) the duration of operation. An output was defined as the surgical fee that was charged for reimbursement. Each surgeon’s efficiency score was calculated using data envelopment analysis. Using the medians of efficiency scores in each surgical specialty, the authors inferred Gini coefficients and their standard errors in each year and in each surgical fee schedule by the Bootstrap methods. Results The authors analyzed 16,307 surgical procedures during the study period of 2013-18. There was no statistically significant difference in the Gini coefficients between the years and between the surgical fee schedules (p > 0.05). Conclusions The authors demonstrated that the degree of inequality of Japanese surgical fee schedule remained constant from 2013 through 2018.