Imai Keiko
St. Marianna University, School of Medicine 2-16-1 Sugao, Miyamae-ku, Kawasaki, 216-8511, Japan.
Igaku Butsuri. 2006;26(3):85-96.
Two fields of radiology, medical imaging and radiation therapy, are coded separately in medical fee system, and the health care statistics of 2003 shows that expenditure on the former was 5.2% of the whole medical cost and the latter 0.28%. Introduction of DPC, an abbreviation of Diagnostic Procedure Combination, was carried out in 2003, which was an essential reform of medical fee payment system that have been managed on fee-for-service base throughout, and 22% of beds for acute patients care are under the control of DPC payment in 2006. As medical imaging procedures are basically classified in inclusive payment in DPC system, their accurate statistics cannot be figured out because of the lack of description of individual procedures in DPC bills. Policy-making of medical economics will suffer a great loss from the deficiency of detailed data in published statistics. Important role in clinical diagnoses of CT and MR results an increase of fee paid for them up to more than half of total expenditure on medical imaging. So, dominant reduction of examination fee has been done for MR imaging, especially in 2002, to reduce the total cost of medical imaging. Follows could be featured as major topics of medical imaging in health insurance system, (a) fee is newly assigned for electronic handling of CT-and-MR images, and nuclear medicine, and (b) there is still a mismatch between actual payment and quality of medical facilities. As matters related to medical imaging, the followings should be stressed; (a) numbers of CT and MR units per population are dominantly high among OECD countries, but, those controlled by qualified radiologists are at the average level of those countries, (b) there is a big difference of MR examination quality among medical facilities, and (c) 76% of newly-installed high-end MR units are supplied by foreign industries. Hopefully, there will be an increase in the concern to medical fee payment system and health care cost because they possibly influence patient care, personnel affairs in clinical facilities, technological development of medical devices, and so on.
放射学的两个领域，即医学成像和放射治疗，在医疗费用系统中是分开编码的。2003年的医疗保健统计数据显示，前者的支出占整个医疗费用的5.2%，后者为0.28%。2003年引入了诊断程序组合（Diagnostic Procedure Combination，简称DPC），这是对一直以来按服务收费管理的医疗费用支付系统的一项重大改革，到2006年，22%的急性病患者护理床位由DPC支付管理。由于在DPC系统中，医学成像程序基本上归类为综合支付，DPC账单中缺乏对各个程序的描述，因此无法得出其准确统计数据。已公布统计数据中详细数据的缺失将给医学经济学决策带来巨大损失。CT和MR在临床诊断中发挥重要作用，这使得它们的收费增加，高达医学成像总支出的一半以上。因此，特别是在2002年，对MR成像检查费进行了大幅下调，以降低医学成像的总成本。以下内容可能是医疗保险系统中医学成像的主要议题：（a）为CT和MR图像以及核医学的电子处理新设定了费用；（b）实际支付与医疗设施质量之间仍存在不匹配。关于与医学成像相关事宜应强调以下几点：（a）经合组织国家中，人均CT和MR设备数量占主导地位地高，但由合格放射科医生操作的设备数量处于这些国家的平均水平；（b）各医疗设施之间MR检查质量存在很大差异；（c）76%的新安装高端MR设备由外国企业供应。希望人们对医疗费用支付系统和医疗保健成本的关注度会有所提高，因为它们可能会影响患者护理、临床机构的人事安排、医疗设备的技术发展等。
