Kyoto University, Graduate School of Medicine, Department of Healthcare Economics and Quality Management Yoshidakonoecho, Sakyo-ku, Kyoto City, Kyoto 606-8501,
Health Policy. 2012 Oct;107(2-3):194-201. doi: 10.1016/j.healthpol.2012.01.002. Epub 2012 Jan 23.
In 2003, Japan introduced the prospective payment system (PPS) with diagnosis-related groups (DRG) rearranged grouping system called the diagnostic procedure combination/per-diem payment system (DPC/PDPS). Even after eight years, little is known about the effects of DPC/PDPS. The purpose of this study was to examine the effects of DPC/PDPS on resource usage and healthcare quality.
Using 2001-2009 (fiscal year) administrative data of acute myocardial infarction patients, four indices, including inpatient total accumulated medical charges, length of stay (LOS), mortality rate, and readmission rate, were compared between patients reimbursed by DPC/PDPS or by fee-for-service.
DPC/PDPS significantly reduced total accumulated medical charges by $1061 (95% confidence interval [CI], -2007, -116) and LOS by 2.29 days (95% CI, -3.71, -0.88) after risk adjustment. However, mortality rate (Odds ratio [OR], 0.94; 95% CI, 0.73, 1.21) was unchanged. Furthermore, DPC/PDPS increased the readmission rate (OR, 1.37; 95% CI, 1.03, 1.82).
This study showed that DPC/PDPS was associated with reduced resource usage, but not improved healthcare quality, as with DRG/PPSs in other countries. To achieve successful healthcare reform, further discussion on additional motives will be required.
2003 年，日本引入了按诊断相关分组（DRG）重新排列分组系统的预付费制（PPS），称为诊断程序组合/每日支付系统（DPC/PDPS）。即使在八年之后，对于 DPC/PDPS 的效果也知之甚少。本研究的目的是检验 DPC/PDPS 对资源利用和医疗质量的影响。
利用 2001-2009 年（财政年度）急性心肌梗死患者的行政数据，将接受 DPC/PDPS 或按服务收费补偿的患者的四个指标，包括住院总累计医疗费用、住院时间（LOS）、死亡率和再入院率进行比较。
经过风险调整后，DPC/PDPS 显著降低了 1061 美元的总累计医疗费用（95%置信区间[CI]，-2007，-116）和 2.29 天的 LOS（95%CI，-3.71，-0.88）。然而，死亡率（比值比[OR]，0.94；95%CI，0.73，1.21）不变。此外，DPC/PDPS 增加了再入院率（OR，1.37；95%CI，1.03，1.82）。
本研究表明，DPC/PDPS 与资源利用减少有关，但与其他国家的 DRG/PPS 不同，与医疗质量的提高无关。为了实现成功的医疗改革，需要进一步讨论其他动机。
