Abstract
The Japanese population is aging and requires regional health facilities to cooperate to use medical resources efficiently. This study evaluated the impact of regional cooperation on the efficiency of medical care delivery in secondary medical areas. The discharge adjustment implementation rate of each secondary medical area was used as a proxy for regional cooperation. The study data were obtained from publicly available sources. The efficiency scores of secondary medical areas were calculated using the input-oriented Banker–Charnes–Cooper model for Data Envelopment Analysis. The inputs used were the number of general beds and the average length of hospital stay for each secondary medical area. The outputs used were the number of discharged patients and inpatient medical expenses per person. In addition, the relationship between discharge adjustment implementation rates and efficiency scores were assessed using tobit multiple regression analysis. The models were adjusted for the 7 variables. Ten secondary medical areas had an efficiency score of 1.00 (i.e., highest efficiency). Tobit regression analysis was performed on the 340 secondary medical areas for which efficiency scores were obtained. The discharge adjustment implementation rates and efficiency scores were significantly positively correlated (p = 0.032). While studies that quantitatively evaluate regional cooperation and efficiency are limited, these findings suggest that implementing regional cooperation may improve the efficiency of medical care delivery in secondary medical areas.
Highlights
The conventional medical system in Japan is hospital-centric, that is, it aims to provide all necessary care within one hospital
Tobit regression analysis was performed on the 340 secondary medical areas for which efficiency scores were obtained
We found a significant positive relationship between discharge adjustment implementation rates and efficiency scores obtained using Data Envelopment Analysis (DEA)
Summary
The conventional medical system in Japan is hospital-centric, that is, it aims to provide all necessary care within one hospital. The system is mainly designed for adolescent or middle-aged patients and do not have clear divisions for acute, rehabilitation, and chronic care. The Japanese population is aging, and the prevalence of chronic conditions is increasing. Patients with chronic conditions often require continuous medical care to manage their symptoms, while maintaining or improving their quality of life. It is becoming increasingly difficult to navigate the intrahospital referrals that are necessary to provide treatment within a single medical institution. With the aging population and low birthrate, there is an increasing burden on the medical system and younger generations. This trend threatens the sustainability of the medical system (Ministry of Health, Labour and Welfare Health Insurance Bureau, 2015; National Council Reform of Social Security System, 2013)
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