Influence of Japan's New Diagnosis Procedure Combination-Based Payment System on the Surgical Sector: Does it Really Shorten the Hospital Stay?

Laparoscopic spleen-preserving distal pancreatectomy with and without splenic vessel preservation: The role of the Warshaw procedure

“…Moreover, despite the absence of grade B or C pancreatic fistula, the postoperative hospital stay of both groups was longer compared to the previous reports (20,28). In Japan, university hospitals use the Diagnosis Procedure Combination (DPC) system (29). In cases in which patients diagnosed with a benign pancreatic tumor undergo a laparoscopic distal pancreatectomy, national health insurance covers the hospital stay for more than 2 weeks.…”

Differential Effects of Declining Rates in a Per Diem Payment System

“…hospitals use classic measures to shorten ALOS by raising the efficiency of medical treatment (Borghans et al, 2012;Besstremyannaya, 2011;Kuwabara et al, 2011;Suwabe, 2004). However, both technical and cost efficiency of Japanese local public hospitals show only a minor improvement following the reform (Besstremyannaya, 2013), and the impact on hospital costs is ambiguous (Nishioka, 2010;Yasunaga et al, 2006;Yasunaga et al, 2005a). Moreover, the per diem payment system might not have shortened ALOS in a number of cases (Nawata and Kawabuchi, 2012;Yasunaga et al, 2006).…”

“…Overall, the evidence for both cohorts is consistent with Hypothesis I (for most MDCs, hospitals in percentiles 0-25 increase their ALOS and hospitals in percentiles 51-100 decrease it) and Hypothesis II (larger decline of ALOS at hospitals in higher percentiles of ALOS). A failure of Hypothesis I for some MDCs in cohort 1 may be explained by a large prevalence of surgical patients, for whom material costs are well covered within the DPC schedule (Yasunaga et al, 2006). MDC2 'Eye system', where nonsurgical patients constitute only 5% (Hayashida et al, 2009;Kuwabara et al, 2008), may provide an example of such case.…”

“…Similarly,Yasunaga et al (2006) argue that decline in ALOS often occurs at large hospitals that deal primarily with surgical patients.3 Additionally, the shrinkage of the labor force resulted in a falling share of enrollees in insurance plans for workers and a growing share of enrollees in subsidized health insurance plans.…”

Are We Lacking Economic Evaluations in Gastric Cancer Treatment?

“…Compared with open surgery, where costs range from US$2,892 to US$30,309 (2012) depending on the extent of lymphadenectomy and type of reconstruction method [17][18][19][20][21][22], the costs of minimally invasive surgery appear to be favorable, from US$2,091 (2012) [23] for an endoscopic mucosal resection, to upwards of US$5,895 to US$10,279 (2012) [17,19,21,22] [17,19,22]. Further economic evidence is required to understand how surgical innovation impacts the costs and resource use of treating gastric cancer.…”