Impact of the Japanese Diagnosis Procedure Combination-based Payment System in Japan
Impact of the Japanese Diagnosis Procedure Combination-based Payment System in Japan
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DOI：
10.1007/s10916-008-9220-2
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发表时间：
2010-02-01
影响因子：
5.3
通讯作者：
Yamauchi, Kazunobu
中科院分区：
文献类型：
--
作者：
Wang, Kai;Li, Ping;Yamauchi, Kazunobu
日本的健康保险制度从1958年开始对个人治疗服务实行按次收费制度。这种制度存在导致检查和药品管理增加的结构性问题。 2003年4月推出了名为DPC的固定费用支付系统，以解决按服务收费系统的问题。我们根据2003年和2004年的数据，评估了DPC在日本的影响，得出以下结论：第一，日本引入DPC并不能降低医疗费用的绝对值；第二，提高机构内部效率，例如减少平均住院时间；第三，基于DPC的诊断分类被认为可以有效简化EBM框架内的医疗费用体系，并为患者提供信息；第四，实行DPC后，固定收费制度仍存在结构性问题，如检查和治疗质量低、患者选择和编码上行等。因此，其引入应非常谨慎。我们将通过评估这些问题，为建立更好的医疗收费制度做出更大的努力。
In the health insurance system of Japan, a fee-for-service system has been applied to individual treatment services since 1958. This system involves a structural problem of causing an increase in examination and drug administration. A flat-fee payment system called DPC was introduced in April 2003 to solve the problems of the fee-for-service system. Based on the data of 2003 and 2004, we assessed the impact of DPC in Japan, and obtained the following conclusions: First, the introduction of DPC in Japan could not decrease the absolute value of medical costs; second, the internal efficiency of the institutions was improved, for example, by reducing the mean length of hospitalizations; third, the DPC-based diagnosis classification is considered to be effective for simplifying the medical fee system within the framework of EBM and for providing patients with information; and fourth, after introduction of the DPC, structural problems remain in the flat-fee payment system, such as examination and treatment of low quality, selection of patients and up coding. Its introduction should thus be performed with sufficient caution. We will make greater efforts to establish a better medical fee system by evaluating these problems.