Japanese surgical resource utilization in 2016

Abstract

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.

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

“…12-030-3) as above. Since the present study is based on our three previous ones, we intentionally used the similar methods in data collection and analysis framework to those described in our previous ones [1][2][3].…”

“…It has 1,152 beds and has a surgical volume of approximately 9,000 cases annually. The necessary information for the present study was extracted from surgical records in its electronic medical record system [1][2][3].…”

“…We previously reported three studies that evaluated the Japanese surgical fee schedule in terms of resource utilization using data envelopment analysis (DEA) [1][2][3]. We demonstrated that the Japanese surgical fee schedule failed to re ect resource utilization and was unequal among surgical specialties in spite of its biannual revisions in 2014 and 2016 [1][2][3].…”

“…resources), or to evaluate inputs while controlling the amount of outputs [6,7]. We can evaluate the equality of the fee schedule in relation to healthcare resources utilization by comparing the e ciency scores [1][2][3]. If the surgical fee schedule were perfectly fair and equal in relation to resources utilization for all surgeries, all surgeons would be located on the e ciency frontier, and all their e ciency scores would be one.…”

“…If the surgical fee schedule were perfectly fair and equal in relation to resources utilization for all surgeries, all surgeons would be located on the e ciency frontier, and all their e ciency scores would be one. However, no study has ever used DEA to evaluate the equality of Japanese fee schedule except our previous ones [1][2][3].…”