Financial Sustainability of the Japanese Medical Payment System: Analysis of the Japanese Medical Expenditure for Educational Hospitalization of Patients with Type 2 Diabetes

Abstract

Japanese medical expenditures have increased rapidly in recent years and are predicted to continue rising. Indeed, it remains uncertain whether the current Japanese medical system can be sustained. In this paper, we analyzed the medical expenditures for educational hospitalization of patients with type 2 diabetes. A dataset of 6173 patients from 36 hospitals was used in the analysis. The sample period was from July 2008 to March 2012. We analyzed the medical expenditures in two ways. First, we analyzed the length of hospital stay (LOS). Next, we analyzed the daily expenditure per patient. The Box-Cox transformation model was used in the first analysis and the ordinary least squares method in the second. Comorbidities and complications prolonged LOS and increased daily expenditures. The LOS was significantly different among hospitals. On the other hand, the differences in daily expenditures among hospitals were relatively small, such that LOS was the main determinant of medical expenditures. Previous studies suggested that LOS could be shortened without degradation of medical quality. Moreover, LOS could be controlled by introducing proper critical paths and improving and standardizing educational programs. Hence, it would be possible to control the medical expenditures for this disease.

Comparison of the Length of Stay and Medical Expenditures among Japanese Hospitals for Type 2 Diabetes Treatments: The Box-Cox Transformation Model under Heteroscedasticity

“…In the case of educational hospitalization, the ALOS was 13.7 days with a SD of 6.7 days, and the AME was 370,336 yen with a SD of 152,895 yen for 6,178 patients. Therefore, the ALOS was 4.4 days longer and AME was 91,344 yen higher for regular patients than for those with an educational hospitalization [24]. Moreover, the coefficients of variation (=SD/average) became 70% for LOS and 59% for medical expenditures.…”

“…The results of the estimation are presented in Table 3. The average daily medical expenditure (ADME) for regular patients was 27,375 yen, a little bit smaller than the ADME for educational hospitalization (27,983 yen) [24]. The estimates of Comorbidities and Complication were positive and significant at the 1% level.…”

“…This means that 77% of medical expenditures for diabetes were for these patients. As in the previous study [24], we only used the data of patients: 1) who were treated in clinical departments that mainly treat diabetes; and 2) whose principle disease was diabetes. Of the 21,603 patients who satisfied these criteria, 14,193 were regular patients.…”

“…They found a large variation among hospitals in average length of stay (ALOS), and that ALOS at some hospitals was unreasonably long even after eliminating the influence of patient characteristics. These researchers also evaluated the daily medical expenditure (DME) per patient [24]. Unlike ALOS, the variation in average daily medical expenditures (ADME) among hospitals were rather small, with the difference between the largest and smallest being just 15% of the overall average.…”

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

“…We can use the BC MLE if the null hypothesis is accepted. Nawata and Kawabuchi [19] considered a further test when the null hypothesis is accepted. But the null hypothesis consists of compounded assumptions, and the further test is not necessary if the null hypothesis is accepted.…”