Impact of the Japanese Diagnosis Procedure Combination-based Payment System on Cardiovascular Medicine-related Costs

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  • Yasunaga Hideo
    Department of Planning, Information & Management, University of Tokyo Hospital
  • Ide Hiroo
    Department of Planning, Information & Management, University of Tokyo Hospital
  • Imamura Tomoaki
    Department of Planning, Information & Management, University of Tokyo Hospital
  • Ohe Kazuhiko
    Department of Planning, Information & Management, University of Tokyo Hospital

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  • Ohe K: Impact of the Japanese Diagnosis Procedure Combination-based Payment System on cardiovascular medicine-related costs
  • Impact of the Japanese diagnosis procedure combination-based system on the cardiovascular medicine-related costs

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Abstract

In 2003, a lump-sum payment system based on Diagnosis Procedure Combinations (DPC) was introduced to 82 specific function hospitals in Japan. While the US DRG/PPS system is a “per case payment” system, the DPC based payment system adopts a “per day payment.” It is generally believed that the Japanese system provides as much of an incentive as the DRG/PPS system to shorten the average length of stay (LOS). We performed an empirical analysis of the effect of LOS shortening on hospital revenue and expenditure under the DPC-based payment system, particularly in cardiovascular diseases. We also point out fundamentally controversial aspects of the current system.<br> A total 109 cases were selected from patients hospitalized at the University of Tokyo Hospital from May to July, 2003 and classified into one of three categories: (1) cardiac catheter interventions, (2) cardiac catheter examinations, and (3) other conservative treatments. We analyzed the changes in profit per day in cases of a reduction in average LOS and an increase in the number of cases.<br> In category (1) profit increased significantly in conjunction with reduced LOS. In category (2) profit increased only minimally. In category (3), profit increased rarely and sometimes decreased.<br> In cases of conservative treatment, profits sometimes decreased because an increase in material costs exceeded the increase in revenue. It therefore became clear that the DPC-based payment system does not decisively provide an economic incentive to reduce LOS in cardiovascular medicine. <br>

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