New prospective payment system in Japan

Ishikawa, Kazuhiro; Yamamoto, Masato; Kishi, Donald T.; Nabeshima, Toshitaka

doi:10.2146/ajhp040487

Cited by 11 publications

(5 citation statements)

References 4 publications

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“…At present, the operation fee has been excluded in the inclusive payment on the new system called the Diagnosis Procedure Combination (DPC) [37] that begun in 2003 at 80 private and public university hospitals, a public cancer hospital, and a public cardiac care hospital. However, the hospitals have defrayed the cost of disposable operation equipment that exceeds the health insurance payment.…”

Section: Discussionmentioning

confidence: 99%

Disadvantage of Operation Cost in Laparoscopy-Assisted Distal Gastrectomy under the National Health Insurance System in Japan

Hoya

Taki²,

Tanaka³

et al. 2010

Dig Surg

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Background: The utility and problems including the socioeconomic aspect of laparoscopy-assisted distal gastrectomy for gastric cancer have not been fully evaluated. Subjects and Methods: We compared open distal gastrectomy and laparoscopy-assisted distal gastrectomy for the clinical benefit, quality of life, and problems of operation cost by the reference documents in which the difference between open distal gastrectomy and laparoscopy-assisted distal gastrectomy was examined in detail. The reference documents retrieved by the key words ‘gastric, cancer, laparoscopic, surgery’ were 22 in PubMed with the following limits activated: Humans, Clinical Trial, Meta-Analysis, Randomized Controlled Trial, Review, English, Core clinical journals, published in the last 10 years. Results: The operation time of laparoscopy-assisted distal gastrectomy is longer than that of open distal gastrectomy. However, if skilled, the blood loss of laparoscopy-assisted distal gastrectomy is less, the hospitalization days and the duration of fasting after laparoscopy-assisted distal gastrectomy are shorter than those after open distal gastrectomy. The number of excised lymph nodes and the incidence of postoperative complications were similar between laparoscopy-assisted distal gastrectomy and open distal gastrectomy. On the other hand, in the national health insurance system, the operation fee of open distal gastrectomy was USD 6,637 as compared to USD 7,586 for laparoscopy-assisted distal gastrectomy. In spite of the USD 949 difference in the operation fee, the use of disposable instruments for laparoscopy-assisted distal gastrectomy results in a deficit of USD 1,500 over open distal gastrectomy. Conclusion: In spite of the medical superiority of laparoscopy-assisted distal gastrectomy over open distal gastrectomy (if a skilled surgeon operates) as less invasive surgery, laparoscopy-assisted distal gastrectomy is associated with less financial benefit to the hospital as compared to open distal gastrectomy in the current Japanese health insurance system.

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Section: Discussionmentioning

confidence: 99%

Disadvantage of Operation Cost in Laparoscopy-Assisted Distal Gastrectomy under the National Health Insurance System in Japan

Hoya

Taki²,

Tanaka³

et al. 2010

Dig Surg

View full text Add to dashboard Cite

show abstract

“…At present, the operation fee has been excluded from the inclusive payment on the new system called the Diagnosis Procedure Combination （DPC） [17] that begun in 2003 at many public and private university hospitals, a public cancer center, and a public cardiac care hospitals. Although, the deficit of the hospital has been reduced by the revision of the insurance system, the hospitals have defrayed the cost of disposable operation equipments that exceeds the health insurance coverage.…”

Section: Discussionmentioning

confidence: 99%

The Simulation of Operation Cost in Laparoscopy-Assisted and Laparoscopic Distal Gastrectomy Under the National Health Insurance System in Japan

Hoya¹

2017

ASS

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Abstract:The utility and problems including the socioeconomic aspect of laparoscopy-assisted (LADG) and laparoscopic distal gastrectomy (LDG) for gastric cancer has not been fully evaluated. We compared between open distal gastrectomy (ODG), LADG and LDG, the clinical benefit and quality of life by the reference documents. The problems of operation cost were derived by simulating the material used for each operation with Billroth I (B-I) reconstruction, and calculating the operation fee under the national health insurance system in Japan. The operation time of LADG and LDG was longer than that of ODG. However, the intraoperative blood loss of LADG and LDG was less and the postoperative hospital stay as well as the duration of fasting after LADG and LDG were shorter than those after ODG. The number of excised lymph nodes and the incidence of postoperative complications were comparable between LADG, LDG and ODG. On the other hand, in the national health insurance system, the operation fee of ODG was US$7187 as compared to US$8012 for LADG and US$7962 for LDG. In spite of the US$825 and US$775 difference in the operation fee, the use of disposable instruments for LADG and LDG results in the deficit of approximately US$650 and US$850 over ODG, respectively. In spite of the medical superiority of LADG and LDG over ODG as less invasive surgery, LADG and LDG in the current Japanese health insurance system are associated with less financial benefit to the hospital as compared to ODG.

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“…(), and Ishikawa et al . (). (6) 2007–2010 denote the time period July to December in each year; 2011/2012 denotes July 2011 to March 2012.…”

Section: Datamentioning

confidence: 97%

Differential Effects of Declining Rates in a Per Diem Payment System

Besstremyannaya

2014

Health Economics

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The paper demonstrates differential effects of a prospective payment system with declining per diem rates, dependent on the percentiles of length of stay. The analysis uses dynamic panel data estimates and a recent nationwide administrative database for major diagnostic categories in 1068 Japanese hospitals in 2006-2012 to show that average length of stay significantly increases for hospitals in percentiles 0-25 of the pre-reform length of stay and significantly decreases for hospitals in percentiles 51-100. The decline of the average length of stay is larger for hospitals in higher percentiles of the length of stay. Hospitals in percentiles 51-100 significantly increase their rate of nonemergency/unanticipated readmissions within 42 days after discharge. The decline in the length of total episode of treatment is smaller for hospitals in percentiles 0-25. The findings are robust in terms of the choice of a cohort of hospitals joining the reform. The paper discusses applicability of 'best practice' rate-setting to help improve the performance of hospitals in the lowest quartile of average length of stay. Copyright © 2015 John Wiley & Sons, Ltd.

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New prospective payment system in Japan

Cited by 11 publications

References 4 publications

Disadvantage of Operation Cost in Laparoscopy-Assisted Distal Gastrectomy under the National Health Insurance System in Japan

Disadvantage of Operation Cost in Laparoscopy-Assisted Distal Gastrectomy under the National Health Insurance System in Japan

The Simulation of Operation Cost in Laparoscopy-Assisted and Laparoscopic Distal Gastrectomy Under the National Health Insurance System in Japan

Differential Effects of Declining Rates in a Per Diem Payment System

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