Performance, Characteristics, and Case Mix in Japanese and American Teaching Hospitals

Ishikawa, Koichi; M, Holt; Kaihara, Shigekoto; Yoshikawa, Aki; Hopkins, Davis S.P.; Mason, Margaret

doi:10.1097/00005650-199306000-00008

Cited by 8 publications

(6 citation statements)

References 2 publications

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“…On the other hand, the major limitation of this study is its inclusion of only two hospitals. Although the LOS patterns identified in the study are consistent with the other available studies on hospital LOS in the United States and Japan (10,11), our study is limited in its generalizability, especially beyond large, urban university hospitals.…”

Section: Discussionsupporting

confidence: 78%

“…2 Few empirical studies have focused specifically on the patterns and determinants of LOS in U.S. and Japanese hospitals. Ishikawa and colleagues (10), comparing two hospitals, one in Japan and the other in the United States, reported that the average LOS was four to eight times higher at the Japanese hospital for four International Classification of Disease categories. Fukuhara and Norton (11) compared three teaching hospitals, one in Japan and two in the United States, and reported that the average LOS for acute myocardial infarction was more than three times higher at the Japanese hospital.…”

mentioning

confidence: 99%

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Hospital Length of Stay in the United States and Japan: A Case Study of Myocardial Infarction Patients

Muramatsu¹,

Liang²

1999

Int J Health Serv

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Patients in Japan stay in the hospital significantly longer than those in the United States. This study investigates factors that may account for the difference from a sociocultural perspective. In an intensive case study on patients with uncomplicated acute myocardial infarction at a university hospital in Japan and its U.S. counterpart, the authors collected data from interviews with patients, their families, physicians, and other medical professionals and from medical, nursing, and billing records. Patients with comparable medical conditions were studied; U.S. patients stayed in the hospital for 8.8 days on average, Japanese patients for 25.0 days. The average total charge of hospitalization was 2.3 times higher in the United States than in Japan. Although length of stay is determined mainly by physicians' clinical judgment and by health care system factors, patients and their family members often actively participate in decision-making about discharge dates. This case study approach revealed how different health care systems manifest themselves in the individual patient's course of illness, which cannot be examined by macro-level comparison of nations' health care systems.

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Section: Discussionsupporting

confidence: 78%

mentioning

confidence: 99%

Hospital Length of Stay in the United States and Japan: A Case Study of Myocardial Infarction Patients

Muramatsu¹,

Liang²

1999

Int J Health Serv

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“…An early example studying patients at a Japanese and an American teaching hospital found that the Japanese LOS was much longer, and the US costs per patient higher; however, the longer Japanese LOS tended to reduce the total cost per patient gap. 4 Another contribution, that examined differences in outcomes for patients hospitalized for six diagnoses in three European countries and three American states, revealed significant variation in readmission rates. 5 Recent research comparing LOS and mortality after surgery of elderly hip fracture patients in three Japanese and two American hospitals found that while the US LOS was much shorter, mortality was significantly higher in that country.…”

Section: Introductionmentioning

confidence: 99%

What causes international variations in length of stay: A comparative analysis for two inpatient conditions in Japanese and Canadian hospitals

Tiessen

Kambara

Sakai

et al. 2013

Health Serv Manage Res

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Hospital average length of stay varies considerably between countries. However, there is limited patient-level research identifying or discounting possible reasons for these differences. This study compares the length of stay of patients in Japan, where it is the longest in the OECD, and Canada, where length of stay is closer to the OECD mean. Administrative patient-level data, including age, gender, co-morbidities, intervention, discharge plan, outcome and length of stay were collected from two Japanese and two Ontario, Canada hospitals for two diagnoses: colorectal cancer surgery and acute myocardial infarction. Analyses examined linkages between patient characteristics, hospitals and countries and length of stay. When controlling for patient demographic characteristics, the incidence of co-morbidities and discharge plan practices, Japanese length of stay tended to be significantly longer than that in Canada for both diagnoses. Mortality rates were not significantly different; however, the readmission rate (28 days or less) for acute myocardial infarction was higher in the Canadian hospitals. The findings indicate that non-clinical factors contribute to sustained international differences in length of stay. These factors may include professional or cultural norms, differing payment schemes and access to long-term care facilities. The study also introduces a protocol that can be used for international patient-level comparisons that can enable effective policy and management learning.

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“…One innovative approach used by the Health BASKET project compared diagnostic related group (DRG) systems in nine European Union (EU) member states using 10-case vignettes and questionnaires regarding the cost and services that patients would have received [4][5][6][7][8][9][10][11][12]. One research compared Japanese and American teaching hospitals by the mean and median of total cost actually incurred for several diseases [13]. Another showed costs incurred for treating acute myocardial infarction (AMI) patients by cost categories such as radiology, laboratory, drugs etc.…”

Section: Introductionmentioning

confidence: 99%

Comparison of price, volume and composition of services provided to inpatients for two procedures between a US and a Japanese academic hospital

Inokuchi¹,

Ikegami²,

Gupta³

et al. 2013

Health

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Background: To drill down into why per capita health expenditures vary between the US and Japan, this exploratory study compares the price, volume and composition of services provided to inpatients for two procedures in an academic hospital in the US, and one in Japan. Methods: Detailed analysis of the amount reimbursed and services delivered was made from claims data for 449 acute myocardial infarction treated with coronary stents placed by percutaneous coronary intervention (PCI) and 115 heart valve dysfunction with heart valve replacement (HVR) cases in Johns Hopkins Hospital (JHH) Baltimore, Maryland, and 34 PCI and 21 HVR cases in Keio University Hospital (KUH), Tokyo. Results: After making appropriate adjustments, the reimbursed amount per discharge at JHH was significantly higher (Wilcoxon ranksum test, p < 0.01) for both medical conditions. This was due to more use of higher priced technology and higher prices for the same technology at JHH compared with KUH. However, medical imaging was performed more frequently at KUH and the reimbursed amounts per unit for the devices were higher at KUH. Analysis of room and board costs showed that the higher staffing level and wages of nurses at JHH was compensated by its shorter average length of stay for PCI, but not for HVR. Conclusion: Detailed analysis of the reimbursed amount and the utilization of services are needed to understand international variations in healthcare spending.

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Performance, Characteristics, and Case Mix in Japanese and American Teaching Hospitals

Cited by 8 publications

References 2 publications

Hospital Length of Stay in the United States and Japan: A Case Study of Myocardial Infarction Patients

Hospital Length of Stay in the United States and Japan: A Case Study of Myocardial Infarction Patients

What causes international variations in length of stay: A comparative analysis for two inpatient conditions in Japanese and Canadian hospitals

Comparison of price, volume and composition of services provided to inpatients for two procedures between a US and a Japanese academic hospital

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