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Article

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

Keywords

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Article

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

Keywords

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Article

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

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

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