Abstract
Aim The aim of this study is to review the influence of functional evaluation coefficient (FEC) II adjustments on reimbursement for hospitals in Japan operating under the diagnosis procedure combination/per-diem payment (DPC/PDPS) system. Methods Publicly available information was used to describe the FEC II adjustment system and to consider its influence on reimbursement for fiscal years (FY) 2018, 2020, and 2022. Moreover, descriptive statistics and multivariate regression analysis were used to consider how the adjustment differed based on hospital and treatment-related characteristics in FY 2022. Results In FY 2022 there were 1764 hospitals operating under the DPC/PDPS system and the FEC II adjustment was highest, on average, for hospitals in the Hokkaido/Tohoku and Chubu regions with a mean adjustment in reimbursement of 0.1033 (+10.33%), respectively, and lowest for hospitals in the Kyushu/Okinawa region with a mean adjustment of only 0.0921 (+9.21%). Based on the results of a multivariate regression analysis, hospitals in the Hokkaido/Tohoku, Kinki, or Chubu regions and those that had more cases related to the nervous system, the circulatory system, hematological disorders, and traumas, burns, and poisoning had a statistically significant positive association with the FEC II adjustment. Conversely, University or Specified DPC/PDPS hospital and those having more cases related to the eye, ears, nose, throat, breast, and musculoskeletal system/connective tissue disorders had a statistically significant negative association with the FEC II adjustment. Conclusion The FEC II adjustment varies by hospital region, hospital type, and the kind of conditions treated by DPC/PDPS hospitals in Japan. New technologies to support DPC/PDPS hospitals that focus on the treatment of musculoskeletal system and connective tissue disorders, for example, and to allow for a reduction in the length of stay of patients may lead to a higher reimbursement for some DPC hospitals.
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