Impact of the Japanese diagnosis procedure combination-based payment system on cardiovascular medicine-related costs
Impact of the Japanese diagnosis procedure combination-based payment system on cardiovascular medicine-related costs
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DOI：
10.1536/ihj.46.855
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发表时间：
2005-09-01
影响因子：
1.5
通讯作者：
Ohe, K
中科院分区：
文献类型：
--
作者：
Yasunaga, H;Ide, H;Ohe, K
2003年，日本在82家特殊功能医院中引入了基于石油诊断程序组合（DPC）的一次性支付系统。美国的DRG/PPS系统是“按案付费”系统，而基于DPC的支付系统则采用“按日付费”。一般认为，日本的制度提供了与DRG/PPS制度一样多的激励，以缩短平均停留时间。我们对基于dpc的支付体系下LOS缩短对医院收支的影响进行了实证分析，特别是在心血管疾病方面。我们还指出了现行制度中存在根本性争议的方面。选择2003年5月至7月在东京大学医院住院的109例患者，将其分为三大类：(1)心导管介入治疗；(2)心导管检查。(3)其他保守治疗。我们分析了在平均LOS减少和病例数量增加的情况下每天利润的变化。在第(1)类中，利润显著增加，同时LOS减少。在第(2)类中，利润只增加了很少。在类别(3)中，利润很少增加，有时会减少。在保守治疗的情况下，利润有时会下降，因为所有材料成本的增加超过了收入的增加。因此，很明显，基于dpc的支付系统并不能决定性地提供所有的经济激励来减少心血管医学的LOS。
In 2003, a lump-sum payment system based oil Diagnosis Procedure Combinations (DPC) was introduced to 82 specific function hospitals in Japan. While the US DRG/PPS system is a "per case payment" system, the DPC based payment system adopts a "per day payment." It is generally believed that the Japanese system provides as much of an incentive as the DRG/PPS system to shorten the average length of stay (LOS). We performed an empirical analysis of the effect of LOS shortening oil hospital revenue and expenditure under the DPC-based payment system, particularly in cardiovascular diseases. We also point out fundamentally controversial aspects of the current system.A total 109 cases were selected from patients hospitalized at the University of Tokyo Hospital from May to July, 2003 and classified into one of three categories: (1) cardiac catheter interventions, (2) cardiac catheter examinations. and (3) other conservative treatments. We analyzed the changes in profit per day in cases of a reduction in average LOS and an increase in the number of cases.In category (1) profit increased significantly in Conjunction with reduced LOS. In category (2) profit increased only minimally. In category (3), profit increased rarely and sometimes decreased.In cases of conservative treatment, profits sometimes decreased because ail increase in material costs exceeded the increase in revenue. It therefore became clear that the DPC-based payment system does not decisively provide all economic incentive to reduce LOS in cardiovascular medicine.