Hamada Yoshinori
Division of Pediatric Surgery, Kansai Medical University, Moriguchi, Japan.
Nihon Geka Gakkai Zasshi. 2005 Oct;106(10):654-8.
The current status of the flat payment system based on the diagnosis procedure combination (DPC) system was examined in pediatric surgery. Many important diseases especially in neonatal surgery are not listed for the DPC system due to either the small number of cases or variations in hospital stay or cost In our university hospital, however, the DPC system was applied to 286 (90.8%) of 315 admissions. Total scores for the admissions were slightly higher (103.5%) in the DPC system compared with the fee-for-service system. Scores for inguinal hernia by day surgery and one-night stay were also slightly higher (102.2%) in the DPC system. Future measures for the DPC system include the provision that most preoperative evaluations should be performed in outpatient clinics and further elective surgery at a separate admission is recommended for patients with benign disease or in good condition. In cases of surgery for emergencies or malignancies, too many examinations should be avoided. Postoperative treatment using a clinical path without complications should be performed to achieve shortening of hospital stays and reduced cost. Problems in the current DPC system are complicated and inadequate classification, probably due to the unique and cost-unbeneficial nature of pediatric surgery. To establish a better medical fee system, further efforts to improve the DPC system should be continued.
我们研究了基于诊断程序组合（DPC）系统的统一支付系统在小儿外科中的现状。由于病例数量少、住院时间或费用存在差异，许多重要疾病（尤其是新生儿外科疾病）未被列入DPC系统。然而，在我们大学医院，315例住院病例中有286例（90.8%）应用了DPC系统。与按服务收费系统相比，DPC系统中住院病例的总分略高（103.5%）。日间手术和住院一晚的腹股沟疝病例得分在DPC系统中也略高（102.2%）。DPC系统未来的措施包括规定大多数术前评估应在门诊进行，对于良性疾病或状况良好的患者，建议另行安排住院进行进一步的择期手术。对于急诊或恶性肿瘤手术，应避免进行过多检查。应采用无并发症的临床路径进行术后治疗，以缩短住院时间并降低成本。当前DPC系统存在的问题是分类复杂且不充分，这可能是由于小儿外科的独特性和成本效益不佳所致。为建立更好的医疗费用系统，应继续进一步努力改进DPC系统。
