Yasunaga Hideo, Ide Hiroo, Imamura Tomoaki, Ohe Kazukiko
Department of Planning, Information, and Management, University of Tokyo Hospital, 7-3-1 Hongo, Tokyo, Japan.
Surg Today. 2006;36(7):577-85. doi: 10.1007/s00595-006-3203-z.
In 2003, the Diagnosis Procedure Combination (DPC)-based payment system was introduced on a trial basis in 82 major Japanese hospitals. We analyzed the influence of this system on hospital revenue and expenditure, focusing on whether it reduces the length of stay in hospital (LOS), particularly in the surgical sector.
We studied 120 patients hospitalized at the University of Tokyo hospital between May and July 2003, including 93 surgical patients who underwent operations for gastric, colon, rectal, hepatic, or mammary carcinoma; arteriosclerosis obliterans; appendicitis; adult hernia inguinalis; or varicose veins, and 27 nonsurgical patients hospitalized for recurrent gastric carcinoma, ileus, appendicitis, or mild acute pancreatitis. We analyzed the changes in profit per day in patients with a reduced LOS using the simulation model.
Reducing the LOS of the surgical patients resulted in a greater profit; however, there was minimal if any profit increase achieved by reducing the LOS of the medical patients. In fact, when material costs were high, profit decreased.
The DPC-based payment system does not usually offer an economic incentive to shorten the LOS. Expanding our current system will reduce the LOS only in major hospitals, but it will reduce the national average LOS. Thus, the current DPC-based payment system needs to be improved further.
2003年，基于诊断程序组合（DPC）的支付系统在日本82家主要医院进行了试点。我们分析了该系统对医院收支的影响，重点关注其是否能缩短住院时间（LOS），尤其是在外科领域。
我们研究了2003年5月至7月在东京大学医院住院的120例患者，其中包括93例接受胃癌、结肠癌、直肠癌、肝癌、乳腺癌手术；闭塞性动脉硬化；阑尾炎；成人腹股沟疝；或静脉曲张手术的外科患者，以及27例因复发性胃癌、肠梗阻、阑尾炎或轻度急性胰腺炎住院的非外科患者。我们使用模拟模型分析了住院时间缩短患者的每日利润变化。
缩短外科患者的住院时间带来了更大的利润；然而，缩短内科患者的住院时间几乎没有带来利润增加，实际上，当材料成本较高时，利润会下降。
基于DPC的支付系统通常不会提供缩短住院时间的经济激励。扩大我们目前的系统只会在大医院缩短住院时间，但会降低全国平均住院时间。因此，当前基于DPC的支付系统需要进一步改进。
