The Trend of the Policy of a Medical Insurance System and the DPC System Really Offer Incentives for Shortening the Length of Stay or Not

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  • IMAMURA Tomoaki
    University of Tokyo Hospital, Department of Planning, Information & Management
  • YASUNAGA Hideo
    University of Tokyo Hospital, Department of Planning, Information & Management

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  • 特定機能病院を取り巻く諸制度の状況とＤＰＣ導入に伴う影響について

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Abstract

  The trend of the policy of a medical insurance system is heading towards medical-expense reduction. This is not the only problem in the financial crisis of medical insurance. Aging, a decrease in the birthrate, and the trend toward the nuclear family are causes, and the problem has come out in the structure of Japan. The prospective payment system based on the DPC (Diagnosis Procedure Combination) system was introduced into special functioning hospital in 2003. In diagnosis groups in which surgery is performed, shorter hospitalization generally means increased profits. However, income increases are not proportional to patient increases, but they are proportional to material cost increases. Consequently, profits remain low.<br>  In diagnosis groups without surgery, the material cost rates at break-even points are very low, but when they exceed these values, shortening the length of stay results in decreased profits. There is a tendency generally to think that, in DPC, incentives to shorten the length of stay help to the balance sheet. However, in the non-surgical diagnosis groups, shortening the length of stay decreases profits, while in some cases, extending it increases profits unless material costs are reduced as much as possible.

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