Abstract
Background: To drill down into why per capita health expenditures vary between the US and Japan, this exploratory study compares the price, volume and composition of services provided to inpatients for two procedures in an academic hospital in the US, and one in Japan. Methods: Detailed analysis of the amount reimbursed and services delivered was made from claims data for 449 acute myocardial infarction treated with coronary stents placed by percutaneous coronary intervention (PCI) and 115 heart valve dysfunction with heart valve replacement (HVR) cases in Johns Hopkins Hospital (JHH) Baltimore, Maryland, and 34 PCI and 21 HVR cases in Keio University Hospital (KUH), Tokyo. Results: After making appropriate adjustments, the reimbursed amount per discharge at JHH was significantly higher (Wilcoxon ranksum test, p Conclusion: Detailed analysis of the reimbursed amount and the utilization of services are needed to understand international variations in healthcare spending.
Highlights
The Organization for Economic Cooperation and Development (OECD) data show that there is considerable variation in the level of per capita total health expenditures among its member countries [1]
One innovative approach used by the Health BASKET project compared diagnostic related group (DRG) systems in nine European Union (EU) member states using 10-case vignettes and questionnaires regarding the cost and services that patients would have received [4,5,6,7,8,9,10,11,12]
We focus on only two hospitals—the Johns Hopkins Hospital (JHH) in Baltimore, Maryland and Keio University Hospital (KUH) in Tokyo, Japan
Summary
The Organization for Economic Cooperation and Development (OECD) data show that there is considerable variation in the level of per capita total health expenditures among its member countries [1]. One research compared Japanese and American teaching hospitals by the mean and median of total cost incurred for several diseases [13]. Another showed costs incurred for treating acute myocardial infarction (AMI) patients by cost categories such as radiology, laboratory, drugs etc. Results: After making appropriate adjustments, the reimbursed amount per discharge at JHH was significantly higher (Wilcoxon ranksum test, p < 0.01) for both medical conditions. This was due to more use of higher priced technology and higher prices for the same technology at JHH compared with KUH. Conclusion: Detailed analysis of the reimbursed amount and the utilization of services are needed to understand international variations in healthcare spending
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