Abe M A
Med Care. 1985 Sep;23(9):1055-66.
Facing spiraling medical costs, Japan and many industrialized countries in the West have tried to control reimbursements to medical providers by setting reimbursement rates. The United States' diagnosis-related groups' (DRGs) pricing has attracted a considerable amount of attention in recent years. This article discusses Japan's hospital reimbursement scheme called the point system, which sets a fixed fee for each item of service, and evaluates Japan's system by comparing it with the United States' DRGs. The article points out that Japan's reimbursement scheme encourages individualized care but fails to provide incentives for it to operate efficiently, and that the design of Japan's system has invited cross-subsidization between complex ailments and less complex ones, and between technical procedures and ancillary services. Some Japanese private hospitals survive only by providing more diagnostic tests and drugs. Japan's cultural and institutional structure that has a critical bearing on her reimbursement system is also discussed to provide a better understanding of the system.
面对不断攀升的医疗成本，日本和许多西方工业化国家试图通过设定报销费率来控制向医疗服务提供者的报销金额。近年来，美国的诊断相关分组（DRGs）定价备受关注。本文讨论了日本的医院报销制度——点数制，该制度为每项服务设定固定费用，并通过与美国的DRGs进行比较来评估日本的制度。文章指出，日本的报销制度鼓励个性化护理，但未能为其高效运作提供激励措施，而且日本制度的设计导致了复杂疾病与不太复杂疾病之间、技术程序与辅助服务之间的交叉补贴。一些日本私立医院仅通过提供更多诊断测试和药品来维持运营。文章还讨论了对日本报销制度有重大影响的文化和制度结构，以便更好地理解该制度。
