Chino M
Department of Cardiology, National Tokyo Medical Center, Tokyo.
J Cardiol. 2001 Feb;37(2):83-90.
Disease-specific cost analysis is rarely performed in Japan, but is essential for reform of the healthcare reimbursement system and assessment of procedural fees.
The actual cost associated with the procedural fee of the percutaneous transluminal coronary angioplasty (PTCA) procedure was estimated by dividing into four categories: labor, disposable materials, expenses, and equipment costs. The special cost associated with PTCA devices such as angioplasty balloon and stent was responsible for the majority of PTCA-related hospitalization costs, but was not included in our survey. The six institutions that participated in the survey belong to the national, Red Cross, and Saiseikai organizations. Time study for labor was omitted, and procedural time was predetermined at 3 hours.
The labor cost amounted to yen 65,000 to yen 98,000/procedure. To calculate the cost of disposable materials across all six hospitals, a universal amount of yen 60,000 from a model hospital was used. The expenses ranged from yen 1,000 to yen 39,000, and the expenditure plus capital cost from yen 95,000 to yen 224,000, showing significant differences between the hospitals. The total mean cost was yen 294,000 +/- 55,000, which indicated that every hospital was in deficit.
Compared to Medicare in the United States of America, the procedural fee for Japanese physicians is extremely low, in contrast to the bloated special cost for devices, which causes significant pricing gaps between Japan and USA. The differences in total cost among the hospitals were mainly derived from the cost for angiographic equipment. Our survey did not include any private hospitals, but the PTCA-related procedural fee is less than the actual cost under the current health insurance reimbursement scheme at all hospitals.
