Impact of the Japanese Diagnosis Procedure Combination-based Payment System on Cardiovascular Medicine-related Costs

Abstract

SUMMARYIn 2003, a lump-sum payment system based on Diagnosis Procedure Combinations (DPC) was introduced to 82 specific function hospitals in Japan. While the US DRG/PPS system is a "per case payment" system, the DPC based payment system adopts a "per day payment." It is generally believed that the Japanese system provides as much of an incentive as the DRG/PPS system to shorten the average length of stay (LOS). We performed an empirical analysis of the effect of LOS shortening on hospital revenue and expenditure under the DPC-based payment system, particularly in cardiovascular diseases. We also point out fundamentally controversial aspects of the current system.A total 109 cases were selected from patients hospitalized at the University of Tokyo Hospital from May to July, 2003 and classified into one of three categories: (1) cardiac catheter interventions, (2) cardiac catheter examinations, and (3) other conservative treatments. We analyzed the changes in profit per day in cases of a reduction in average LOS and an increase in the number of cases.In category (1) profit increased significantly in conjunction with reduced LOS. In category (2) profit increased only minimally. In category (3), profit increased rarely and sometimes decreased.In cases of conservative treatment, profits sometimes decreased because an increase in material costs exceeded the increase in revenue. It therefore became clear that the DPCbased payment system does not decisively provide an economic incentive to reduce LOS in cardiovascular medicine. (Int Heart J 2005; 46: 855-866)

Effect of treatment modality on in-hospital outcome in patients with subarachnoid hemorrhage: a nationwide study in Japan (J-ASPECT Study)

“…34 In 2010, an estimated 1388 acute care hospitals, representing about 50% of all hospital beds, adopted the DPC system. Data on practices can be obtained from the DPC database, and the attending physician is responsible for clinical data entry for each patient.…”

“…The Japanese DPC database includes data on the following elements: each patient's profile (that is, age, sex, height, weight, smoking index); principal diagnoses (coded according to the International Classification of Diseases and Injuries, 10th revision); comorbidities at admission (coded similarly); complications after admission (coded similarly); and procedures, including surgery, medications, and devices used during hospitalization; length of stay; discharge status; and medical expense. 22,34,35 Institutions using the DPC system encompass a wide variety of centers, including academic, large, urban, and rural hospitals. 15 Of the 847 certified training institutions of the Japan Neurosurgical Society, 393 agreed to participate in the J-ASPECT Study.…”

The Current Status of Cardiovascular Medicine in Japan – Analysis of a Large Number of Health Records From a Nationwide Claim-Based Database, JROAD-DPC –

“…3 The DPC database includes the following individual data: unique hospital identifier, patient age and sex, main diagnoses and comorbidities, drugs and devices, diagnostic and therapeutic procedures, length of stay, and discharge status. Following the same methodology used in the J-ASPECT nationwide stroke registry, 4,5 the combination of JROAD and DPC-based claim data may be helpful to clarify the real-world practice of Japanese CVD other than stroke.…”

Inpatient satisfaction and job satisfaction/stress of medical workers in a hospital with the 7:1 nursing care system (in which 1 nurse cares for 7 patients at a time)

“…Nonetheless, these hospitals are required to improve efficiency and cut costs in each division, e.g., outsourcing of supply processing and distribution system of medical materials, provision of hospital meals, and office staff, to cut down on personnel expenses. In fact, a decrease in profits has already been reported by surgery departments [5][6][7]. Despite their efforts and the existence of such reports, the adjustment coefficient to subsidize the benefit loss of DPC hospitals was abolished in 2010, and financial difficulties are anticipated.…”