DRG導入に向けての唇顎口蓋裂治療費の分析 [in Japanese] Analysis of the Present Situation of Medical Cost for Cleft Lip and Palate : The Provision for Introduction of DRG [in Japanese]
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欧米では医療費の適正化を図るため,出来高払い方式に代わり,診断群別包括支払い方式(DRG/PPS;Diagnosis Related Group/Prospective Payment System)が導入されており,わが国においても近い将来の導入が検討されている.そこで唇顎口蓋裂患者を対象に,医療費の分析を行い,DRG/PPSへの対応について検討した.<BR>対象は1998年4月より1999年12月までに当科で入院加療を行った唇顎口蓋裂患者51例である.51例を治療内容別に,1)口唇形成術9例,2)口蓋形成術14例,3)顎裂部腸骨移植術18例,4)口唇鼻修正術10例に分類した.それぞれの入院費(入院料,手術・麻酔料,検査料,画像診断料)を出来高払い方式による診療報酬点数から算出した.<BR>唇顎口蓋裂治療の中で,初回口唇形成術や口蓋形成術においては,手術料の検討を行えばDRG/PPSの導入は可能であると考えられた.<BR>顎裂部骨移植や口唇鼻修正術では,手術方法に関する細かな分類が必要であった.<BR>DRG/PPS導入前に,現行の診療報酬点数が妥当であるかどうかを明らかにする必要があると考えられた.
A change from the current piecework payment system to the Diagnosis-Related Group/Prospective Payment System (DRG/PPS) has been under discussion for the “ rationalization” of ever-increasing medical expenses. Success of the DRG/PPS partly depends on how appropriate the classification of diagnosis-related groups is going to be. We calculated the hospital charges by method or the progress of medical treatment adopted in cleft lip and palate cases. Also discussed is how to classify diagnosis-related groups, and the feasibility of introducing the DRG/PPS.<BR>The objects were 51 patients that were hospital-treated for cleft lip and palate between April 1998 and December 1999. The breakdown of the 51 is as follows: primary lip plasty,9 cases; primary palatoplasty,14 cases; bone graft to the alveolar cleft,18 cases; and secondary lip and nose repair,10 cases. The hospitalization charge for each case was calculated, based on the table of medical care fee points, from totaling the piecework charges for hospital room and board, surgery and anesthesia, laboratory tests, and imaging. It was thought that the DRG/PPS would be feasible in primary cases of lip plasty and palatoplasy, provided their surgery costs were reexamined. We found that a closer classification would be in order for bone graft and secondary repair cases.<BR>We would also urge a detailed examination of the adequacy of the current medical care fee points, prior to eventual introduction of the DRG/PPS.
- Journal of Japanese Cleft Palate Association
Journal of Japanese Cleft Palate Association 26(1), 125-130, 2001-04-30
Japanese Cleft Palate Association