Abstract
We evaluated the effects of the 2010 revision of the medical payment system on the length of stay (LOS). In this analysis, we assessed not only the average length of stay (ALOS), but also variance of LOS at individual hospitals. We used a dataset of 18,641 type 2 diabetes patients collected from 51 general hospitals. The variables found to affect LOS were age, comorbidities, complications, acute hospitalization, introduced by other hospitals, winter, one-week hospitalization, specific hospitalization period, and principal diseases coded E11.5, E11.6 and E11.7. Although the effect was marginal, the 2010 revision did reduce ALOS, and the reduction was larger as ALOS became longer. On the other hand, we did not find that the variance of LOS within hospitals became smaller. The results of the study suggest that new incentives and assistance to hospitals to help them make efficient use of medical information are needed.
Highlights
In June 2015, the advisory committee of the Ministry of Health, Labour and Welfare [1] submitted the very im-How to cite this paper: Nawata, K. and Kawabuchi, K. (2016) Did the Revision of the Japanese Medical Payment System Work Properly?—An Analysis of Averages and Variances of Length of Hospital Stay for Type 2 Diabetes Patients by Individual Hospital
We consider an analysis of length of stay (LOS) of type 2 diabetes patients by the Box-Cox transformation model when variance differs among hospitals, and the number of hospitals increases to infinity
We evaluated effects of the 2010 revision of the Diagnosis Procedure Combination (DPC)/PDPS, analyzing average length of stay (ALOS) and variance of LOS of individual hospitals
Summary
In June 2015, the advisory committee of the Ministry of Health, Labour and Welfare [1] submitted the very im-How to cite this paper: Nawata, K. and Kawabuchi, K. (2016) Did the Revision of the Japanese Medical Payment System Work Properly?—An Analysis of Averages and Variances of Length of Hospital Stay for Type 2 Diabetes Patients by Individual Hospital. How to cite this paper: Nawata, K. and Kawabuchi, K. “Japan Vision: Healthcare 2035”, to Minister Shiozaki. Japanese medical costs reached 40 trillion yen in fiscal year 2013 [3]. They are expected to increase rapidly as the population ages. Japan has a mandatory health insurance system. Direct payments by patients represented just 12% of total costs, while public expenditures and insurance premiums constituted 39% and 49% of these costs, respectively. It is truly a serious problem whether the Japanese medical payment system is financially sustainable or not
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