Evaluation of the inclusive payment system based on the diagnosis procedure combination with respect to cataract operations in Japan------A comparison of lengths of hospital stay and medical payments among hospitals

Abstract

Following the recommendations of a report submitted by the Central Social Insurance Medical Council concerning the 2002 revision of the Medical Service Fee Schedule, a new inclu-sive payment system, which is based on the Diagnosis Procedure Combination (DPC) sys-tem, was introduced in 82 special functioning hospitals in Japan, effective beginning in April 2003. Since April 2004, the system has been gradually extended to general hospitals that satisfy certain prerequisites. In this paper, the new inclusive payment system is analyzed. Data pertaining to 1,225 patients, who were hospital-ized for cataract diseases and underwent lens operations from July 2004 to September 2005, are used. The lengths of hospital stay and medical payments among hospitals are com-pared. Even after eliminating the influence of patient characteristics, there are large differ-ences among hospitals in average lengths of hospital stay and DPC-based inclusive pay-ments. The highest average inclusive payment is 3.5 times as high as the lowest payment. On the other hand, there are relatively small differ-ences in non-inclusive payments based on the conventional fee-for-service system—the larg-est deviation from the average of all hospitals is approximately 10%. Thus, although payments based on the DPC account for only one-third of the total medical payments for this disease, the major differences in medical payments among hospitals are caused by differences in their DPC-based inclusive payments. The results of the study strongly suggest that revisions of the payment system in Japan are necessary for the efficient use of medical resources in the future

A Long Term Evaluation of the Japanese Medical Payment System for Cataract Surgeries: Did the Medical Policy Reduce the Long Hospital Stay in Japan?

“…The 2006 revision made the non-inclusive payment lower and 2008 revision made it higher. The estimates of Trend and (Trend) 2 were not significant and we could not find time trends unlike the LOS case. The estimate of Over Period dummy was 24,342 and its t-value was 36.218.…”

“…If the LOS exceeds the Specific Hospitalization Period, the inclusive payment goes back to a conventional fee-for-service base. For details of the DPC and DPC/PDPS, see Nawata et al [2]. The joining DPC/ PDPS has not been obligatory, and a hospital can freely choose to join the DPC/PDPS or not if it satisfies necessary conditions [3].…”

An Econometric Analysis of Hospital Length of Stay for Cataract Operations in Japan by the Box-Cox Transformation Model and Hausman Tests: Evaluation of the 2010 Revision of the Medical Payment System*

“…This indicated that there remained large differences among hospitals, even after removing the influences of factors such as patient characteristics, types of principal diseases and the revision of the DPC/PDPS. Although the medical society may express strong disapproval, it may be necessary to give hospitals additional strong incentives suggested by Nawata et al [3] to reduce LOS in the future revision of the DPC/PDPS.…”

“…These hospitals had 474,981 beds, more than half of the total number of beds in all general hospitals [2]. For details of the DPC/PDPS, see Nawata et al [3]. Since DPC hospitals are required to satisfy certain rather costly conditions [4], it is difficult for small hospitals to join the DPC/PDPS.…”

An Analysis of the Medical Costs of and Factors Affecting Diabetes Using the Medical Checkup and Payment Dataset in Japan: Can We Reduce the Prevalence of Diabetes?

“…On the other hand, the differences in daily medical expenditures among hospitals were relatively small, and ALOS accounted for the largest part of total medical expenditures for diabetes. The problem with these studies is that only diabetic inpatients at Diagnosis Procedure Combination (DPC) hospitals were analyzed (for details regarding DPC hospitals, see Nawata et al [41] In Japan, health insurance societies are formed by private companies and central and local governments for their employees. The health insurance societies pay the medical expenses of their members.…”