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Article
Publication date: 13 July 2015

Yoshinori Nakata, Tatsuya Yoshimura, Yuichi Watanabe, Hiroshi Otake, Giichiro Oiso and Tomohiro Sawa

– The purpose of this paper is to examine whether the current surgical reimbursement system in Japan reflects resource utilization after the revision of fee schedule in 2014.

Abstract

Purpose

The purpose of this paper is to examine whether the current surgical reimbursement system in Japan reflects resource utilization after the revision of fee schedule in 2014.

Design/methodology/approach

The authors collected data from all the surgical procedures performed at Teikyo University Hospital from April 1 through September 30, 2014. The authors defined the decision-making unit as a surgeon with the highest academic rank in the surgery. Inputs were defined as the number of medical doctors who assisted surgery, and the time of operation from skin incision to closure. An output was defined as the surgical fee. The authors calculated surgeons’ efficiency scores using data envelopment analysis.

Findings

The efficiency scores of each surgical specialty were significantly different (p=0.000).

Originality/value

This result demonstrates that the Japanese surgical reimbursement scales still fail to reflect resource utilization despite the revision of surgical fee schedule.

Details

International Journal of Health Care Quality Assurance, vol. 28 no. 6
Type: Research Article
ISSN: 0952-6862

Keywords

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Article
Publication date: 8 July 2019

Yoshinori Nakata, Yuichi Watanabe, Hiroto Narimatsu, Tatsuya Yoshimura, Hiroshi Otake and Tomohiro Sawa

The purpose of this paper is to examine from the viewpoint of resource utilization the Japanese surgical payment system which was revised in April 2016.

Abstract

Purpose

The purpose of this paper is to examine from the viewpoint of resource utilization the Japanese surgical payment system which was revised in April 2016.

Design/methodology/approach

The authors collected data from surgical records in the Teikyo University electronic medical record system from April 1 till September 30, 2016. The authors defined the decision-making unit as a surgeon with the highest academic rank in the surgery. Inputs were defined as the number of medical doctors who assisted surgery, and the time of operation from skin incision to closure. An output was defined as the surgical fee. The authors calculated each surgeon’s efficiency score using output-oriented Charnes–Cooper–Rhodes model of data envelopment analysis. The authors compared the efficiency scores of each surgical specialty using the Kruskal–Wallis and the Steel method.

Findings

The authors analyzed 2,558 surgical procedures performed by 109 surgeons. The difference in efficiency scores was significant (p = 0.000). The efficiency score of neurosurgery was significantly greater than obstetrics and gynecology, general surgery, orthopedics, emergency surgery, urology, otolaryngology and plastic surgery (p<0.05).

Originality/value

The authors demonstrated that the surgeons’ efficiency was significantly different among their specialties. This suggests that the Japanese surgical reimbursement scales fail to reflect resource utilization despite the revision in 2016.

Details

International Journal of Health Care Quality Assurance, vol. 32 no. 6
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 16 April 2018

Yuichi Watanabe and Yoshinori Nakata

The purpose of this paper is to examine the association between outpatient orthopedic surgery costs and Japan’s healthcare facilities using a large-scale Japanese medical…

Abstract

Purpose

The purpose of this paper is to examine the association between outpatient orthopedic surgery costs and Japan’s healthcare facilities using a large-scale Japanese medical claims database.

Design/methodology/approach

The authors obtained reimbursement claims data for 8,588 patients who underwent orthopedic surgery between April 1 and September 30, 2014 at 3,347 Japanese healthcare facilities. Regression analysis, using ordinary least squares, examined the association between outpatient orthopedic surgery costs and healthcare facility characteristics. By using surgical fees as proxy for the surgical costs, the authors defined three dependent variables: surgical cost for each outpatient orthopedic surgery; pre- and post-operative cost one month before and after a surgical operation; and total cost for each patient. The authors also defined five independent variables, which capture healthcare facility characteristics and patient-specific factors: bed count; whether healthcare facilities are reimbursed in a diagnosis procedure combination system; patient’s age; sex; and anatomical surgical sites.

Findings

The authors analyzed 6,456 outpatient orthopedic surgical cases performed at 3,085 healthcare facilities. There were significant differences in the surgical costs for outpatient orthopedic surgery among different healthcare facilities by total beds (p=0.000). Multivariate regression analysis shows that surgical costs for outpatient orthopedic surgery are positively and significantly associated with healthcare facilities classified by total beds after adjusting for patient-specific characteristics (p<0.05).

Originality/value

This is the first research to examine the association between costs for outpatient orthopedic surgery and healthcare facility characteristics in Japan. This study via the multivariate regression method showed that outpatient orthopedic surgery is likely to cost higher as healthcare facility size increased. The average incremental costs for each outpatient orthopedic surgery per 100 beds were calculated at $48.5 for surgery, $40.7 for pre- and post-operative care, and $89.2 total cost.

Details

International Journal of Health Care Quality Assurance, vol. 31 no. 3
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 9 May 2016

Yoshinori Nakata, Yuichi Watanabe, Hiroto Narimatsu, Tatsuya Yoshimura, Hiroshi Otake and Tomohiro Sawa

The sustainability of the Japanese healthcare system is in question because the government has had a huge fiscal debt. Despite an enormous effort to cut the deficit, our…

Abstract

Purpose

The sustainability of the Japanese healthcare system is in question because the government has had a huge fiscal debt. Despite an enormous effort to cut the deficit, our healthcare expenditure is increasing every year because of the rapidly aging population. One of the solutions for this problem is to improve the productivity of healthcare. The purpose of this paper is to determine the factors that change surgeons’ productivity in one year.

Design/methodology/approach

The authors collected data of all surgical procedures performed at Teikyo University Hospital from April 1 through September 30 in 2014 and 2015, and computed the surgeons’ Malmquist index (MI), efficiency change (EC) and technical change (TC) using non-radial and non-oriented Malmquist model under the constant returns-to-scale assumptions. The authors then divided the surgeons into two groups; one whose productivity progressed and the other whose productivity regressed. These two groups were compared to identify factors that may influence their MI.

Findings

The only significant difference between the two groups was ECs (p < 0.0001). The other factors, such as TC, experience, surgical volume, emergency cases, surgical specialty, academic ranks, medical schools and gender, were not significantly different between the two groups.

Originality/value

EC is a major determinant of surgeons’ productivity change. The best way to improve surgeons’ productivity may be to enhance their efficiency regardless of their surgical volume and personal backgrounds.

Details

International Journal of Health Care Quality Assurance, vol. 29 no. 4
Type: Research Article
ISSN: 0952-6862

Keywords

Abstract

Details

International Journal of Health Care Quality Assurance, vol. 28 no. 6
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 14 August 2017

Yoshinori Nakata, Tatsuya Yoshimura, Yuichi Watanabe, Hiroshi Otake, Giichiro Oiso and Tomohiro Sawa

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…

Abstract

Purpose

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.

Design/methodology/approach

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.

Findings

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).

Originality/value

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.

Details

International Journal of Health Care Quality Assurance, vol. 30 no. 6
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 28 September 2012

Pietro Giorgio Lovaglio

The purpose of this paper is to provide international data on the occurrence (and rates) of clinical errors, identified by type and consequence in the Lombardy region, and…

Abstract

Purpose

The purpose of this paper is to provide international data on the occurrence (and rates) of clinical errors, identified by type and consequence in the Lombardy region, and to assess empirically the association between hospital accreditation‐type measures and clinical error rates by merging hospital discharge records and medical malpractice claim data in the Lombardy region (Italy).

Design/methodology/approach

Data were drawn from the regional database collecting claims and demands for reimbursement declared by patients hospitalized in regional healthcare structures and regional archives collecting hospital discharge records. To model the variability of clinical errors rates, binomial negative regression models were applied. For improved interpretation of the results, a regression tree methodology was used.

Findings

The results demonstrated that the rate of readmission for the same major diagnostic category and the rate of discharges against medical advice significantly affect the incidence of errors causing patient death, whereas the rate of unscheduled surgical readmission in the operating room significantly affects the rate of surgical error.

Research limitations/implications

The findings confirm that claims data is problematic in nature because of the limited number of claims generally emerging from administrative sources. The article proposes using proper regression models for count data, taking into account over‐dispersion and excess zeroes and classification tree methods for a better interpretation of empirical evidence.

Practical implications

Health structures where quality outcomes have a significant impact on clinical error rates should be monitored in depth, investigating the medical charts of involved patients to identify quality problems and problematic areas.

Originality/value

As a risk management strategy, the combined use of claims data and clinical administrative data is proposed to shed light on the more problematic, error‐prone areas, allowing regional stakeholders to receive relevant, highly cost‐effective and timely information and an in‐depth understanding of the problematic areas in the assessment of risk.

Details

International Journal of Health Care Quality Assurance, vol. 25 no. 8
Type: Research Article
ISSN: 0952-6862

Keywords

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Book part
Publication date: 22 March 2021

Eline Aas, Tor Iversen and Oddvar Kaarboe

The Norwegian health care system is semi-decentralized. Primary care and long-term care (LTC) are the responsibilities of the municipalities. Specialist care is the…

Abstract

The Norwegian health care system is semi-decentralized. Primary care and long-term care (LTC) are the responsibilities of the municipalities. Specialist care is the responsibility of the central government and is organised through four Regional Health Authorities (RHA). Resource use, health outcomes and severity are the three main pillars for priority setting, regularly applied in reimbursement decisions for pharmaceuticals.

The sustainability of health care is challenged in Norway. The main factors are a growing elderly population with high need of complex, coordinated services, an increasing demand for newly approved drugs and advanced technology and a potential shortage of health care personnel.

We present recent trials and policy reforms in Norway aimed at improving care pathways combined with cost containment. Reforms in the pharmaceutical market, both with regard to market access and reimbursement (cost-effectiveness), and regulation of prices, have resulted in cost containment. The primary care sector awaits reform initiatives to recruit and retain physicians as general practitioners. No reform in the hospital sector has had cost containment as a main focus. The sector is characterized with low productivity growth, and expenditures that have increased more than the GDP growth. Waiting times are long, and coordination between sub-sectors of health care has been poor, although the Coordination reform of 2012 has alleviated some of the challenges related to intersectoral coordination. Still, the divided responsibility for health care between the central government and the municipalities creates tensions between national ambitions and local decisions in the financing and provision of health services.

Details

The Sustainability of Health Care Systems in Europe
Type: Book
ISBN: 978-1-83909-499-6

Keywords

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Book part
Publication date: 26 October 2020

Gregg M. Gascon and Gregory I. Sawchyn

Bundled payments for care are an efficient mechanism to align payer, provider, and patient incentives in the provision of health care services for an episode of care. In…

Abstract

Bundled payments for care are an efficient mechanism to align payer, provider, and patient incentives in the provision of health care services for an episode of care. In this chapter, we use agency theory to examine the evolution of bundled payment programs in private and public payer arrangements, and postulate future directions for bundled payment development as a key component in the provision and payment of health care services.

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Article
Publication date: 1 January 1986

Jean L. Freeman, Robert B. Fetter, Robert C. Newbold, Jean‐Marie Rodrigues and Daniel Gautier

Concern over the rising cost of medical care has caused many countries to investigate and implement different methods of cost containment, particularly for hospital…

Abstract

Concern over the rising cost of medical care has caused many countries to investigate and implement different methods of cost containment, particularly for hospital services. In the United States, Medicare replaced its ‘cost‐based’ reimbursement system, in which hospital payments were based on the actual costs incurred in treating patients, with a system that pays hospitals a fixed price per case. Under this new system, all hospital discharges are classified into 467 Diagnosis Related Groups (DRGs) or types of cases based on the patient's age, sex, principal diagnosis, additional diagnoses (comorbidities and complications), surgical procedures performed, and the discharge status. During the first three years of the programme, the payment rate for each DRG is a function of a DRG weight (reflecting relative resource consumption), the hospital's historic costs of treating patients in that DRG, and a federally established rate adjusted for urban/rural differences and census region. In the fourth year the price will be based only on the DRG weight and the federally established rate.

Details

Journal of Management in Medicine, vol. 1 no. 1
Type: Research Article
ISSN: 0268-9235

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