A comparison of correction methods for medical fee revisions in health expenditure analyses using claims data

DOI Web Site
  • Fukuda Haruhisa
    Kyushu University Graduate School of Medical Sciences
  • Sato Daisuke
    Center of Outcomes Research and Economic Evalution for Health, National Institute of Public Health
  • Fukuda Takashi
    Center of Outcomes Research and Economic Evalution for Health, National Institute of Public Health

Bibliographic Information

Other Title
  • レセプトデータを用いた医療費分析における診療報酬改定の補正方法
  • レセプトデータ オ モチイタ イリョウヒ ブンセキ ニ オケル シンリョウ ホウシュウ カイテイ ノ ホセイ ホウホウ

Search this article

Abstract

<p>Objectives: The Guidelines for Economic Evaluations of Healthcare Technologies in Japan (“the Guidelines”) provide a framework for analyses performed under Japan's cost-effectiveness evaluation system. Although these guidelines recommend the use of unit cost corrections at the medical service level to offset the effects of medical fee revisions, this approach has not been compared with other correction methods. This study comparatively examines several correction methods for medical fee revisions in health expenditure analyses using claims data.</p><p>Methods: Data from all patients hospitalized at least once between April 2009 and December 2016 were obtained from medical and diagnosis procedure combination (DPC) claims records. Twenty-five percent of these patients were randomly extracted, and their data are stored in the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB). From the NDB, we obtained a study sample of hospitalized cases with identical (i.e., unchanged) DPC codes or patient definition codes within DPC codes from FY2012 to FY2016. We analyzed the following correction methods: (1) Using FY2016 unit costs for DPC comprehensive components, medical services, pharmaceuticals, and devices; (2) Using FY2016 unit costs for pharmaceuticals and devices, and using the actual medical fee revision rate for other items; (3) Using the overall net revision rate for medical fees, pharmaceuticals, and devices; (4) Using no corrections. To compare the differences in health expenditure estimates among the methods, we calculated the ratios of estimates from Methods 2-4 to that from Method 1.</p><p>Results: Through the periods of FY2012-2013, FY2014-2015, and FY2016, there were 999 cases of unchanged DPC codes and patient definition codes; these constituted 20.3% of all 4,918 DPC codes in FY2016. In contrast, there were 1,528 similar cases (31.1%) through the periods of FY2014-2015 and FY2016. The ratios of estimates from Methods 2, 3, and 4 to that from Method 1 were 1.01, 0.99, and 1.00, respectively. These ratios varied by approximately ±10% among the DPC codes (with some codes exhibiting errors of ±20% or more), but the variations were similar among the methods.</p><p>Conclusion: Method 1 has fundamental issues in practical applications due to its susceptibility to the effects of changes in DPC codes and components. Methods 2 and 3, which are simpler to use, produced estimates without substantial levels of error. With consideration to the accuracy of results and ease of analysis, the net revision rate (Method 3) may provide an optimal solution to account for medical fee revisions in health expenditure estimates.</p>

Journal

Related Projects

See more

Keywords

Details 詳細情報について

Report a problem

Back to top