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Efficiency of inpatient orthopedic surgery in Japan: a medical claims database analysis

Yoshinori Nakata (Teikyo University Graduate School of Public Health, Tokyo, Japan)
Tatsuya Yoshimura (Shin-Yurigaoka General Hospital, Kawasaki, Japan)
Yuichi Watanabe (Waseda University Graduate School of Economics, Tokyo, Japan)
Hiroshi Otake (Showa University School of Medicine, Tokyo, Japan)
Giichiro Oiso (Hamamatsu University School of Medicine, Hamamatsu, Japan)
Tomohiro Sawa (Teikyo University Medical Information and System Research Center, Tokyo, Japan)

International Journal of Health Care Quality Assurance

ISSN: 0952-6862

Article publication date: 14 August 2017



The purpose of this paper is to determine the characteristics of healthcare facilities that produce the most efficient inpatient orthopedic surgery using a large-scale medical claims database in Japan.


Reimbursement claims data were obtained from April 1 through September 30, 2014. Input-oriented Banker-Charnes-Cooper model of data envelopment analysis (DEA) was employed. The decision-making unit was defined as a healthcare facility where orthopedic surgery was performed. Inputs were defined as the length of stay, the number of beds, and the total costs of expensive surgical devices. Output was defined as total surgical fees for each surgery. Efficiency scores of healthcare facilities were compared among different categories of healthcare facilities.


The efficiency scores of healthcare facilities with a diagnosis-procedure combination (DPC) reimbursement were significantly lower than those without DPC (p=0.0000). All the efficiency scores of clinics with beds were 1. Their efficiency scores were significantly higher than those of university hospitals, public hospitals, and other hospitals (p=0.0000).


This is the first research that applied DEA for orthopedic surgery in Japan. The healthcare facilities with DPC reimbursement were less efficient than those without DPC. The clinics with beds were the most efficient among all types of management bodies of healthcare facilities.



This work was supported by Research Fund from Teikyo University Graduate School of Public Health. Ethical approval: all procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

Conflict of interest: the authors declare that they have no conflict of interest.


Nakata, Y., Yoshimura, T., Watanabe, Y., Otake, H., Oiso, G. and Sawa, T. (2017), "Efficiency of inpatient orthopedic surgery in Japan: a medical claims database analysis", International Journal of Health Care Quality Assurance, Vol. 30 No. 6, pp. 506-515.



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