Abstract
Japanese medical expenditures have increased rapidly in recent years and are predicted to continue rising. Indeed, it remains uncertain whether the current Japanese medical system can be sustained. In this paper, we analyzed the medical expenditures for educational hospitalization of patients with type 2 diabetes. A dataset of 6173 patients from 36 hospitals was used in the analysis. The sample period was from July 2008 to March 2012. We analyzed the medical expenditures in two ways. First, we analyzed the length of hospital stay (LOS). Next, we analyzed the daily expenditure per patient. The Box-Cox transformation model was used in the first analysis and the ordinary least squares method in the second. Comorbidities and complications prolonged LOS and increased daily expenditures. The LOS was significantly different among hospitals. On the other hand, the differences in daily expenditures among hospitals were relatively small, such that LOS was the main determinant of medical expenditures. Previous studies suggested that LOS could be shortened without degradation of medical quality. Moreover, LOS could be controlled by introducing proper critical paths and improving and standardizing educational programs. Hence, it would be possible to control the medical expenditures for this disease.
Highlights
The results and hypotheses of these studies lead to the same conclusion: namely, there is no doubt that the Japanese medical expenditure will increase rapidly in the future unless fundamental improvements are made to the medical system
We analyzed the length of hospital stay (LOS) and daily medical expenditures using the data of 6173 patients at 36 hospitals In addition to the numbers of comorbidities and complications, the variables that affected the LOS were Acute Hospitalization, Another Hospital, Day 8, Day 30, and Second Period, (IDC-10) E11.2, E11.4, E11.6 and E11.7 dummies
We found that there were very large differences in average lengths of stay (ALOS) among hospitals even after eliminating the influences of the patient characteristics and principle diseases
Summary
The Japanese total medical expenditures have been constantly increasing on the order of 3% per year except for FY 2001-2006, when the medical payment system was reformed under the Koizumi Cabinet. The Japanese medical expenditures reached 39.2 trillion yen in FY 2012 and increased by 0.6 trillion yen from the previous FY. Since Japanese nominal Gross Domestic Product (GDP) did not increase over the last 20 years, the medical expenditure reached 8.3% of the GDP. The results and hypotheses of these studies lead to the same conclusion: namely, there is no doubt that the Japanese medical expenditure will increase rapidly in the future unless fundamental improvements are made to the medical system
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