title: Implementation of the diagnosis procedure combination in specific-function hospitals.
abstract: A Nobel medical payment system, the Diagnosis Procedure Combination (DPC), was implemented in Nippon Medical School Hospital and 81 other specific-function hospitals in 2003. This payment system depends on the length of hospital stay and diagnosis and medical procedures, and differs from the existing payment system, which depends on a piece rate. The daily payment differs for among almost 2,500 groups of DPC defined by the International Statistical Classification of Diseases and Related Health Problems (ICD-10), and procedures, such as operations (K and J codes of the existing payment system). One of the most important outcomes may be a decrease in lengths of hospital stay, because the range of mean lengths of stay in specific-function hospitals has been officially stated to be 14 to 30 days, and the difference between the longest and shortest mean is almost double. The new medical payment system should stimulate competition among hospitals. In order to decrease the length of stay, we developed clinical pathways for patients undergoing surgery, such as laparoscopic cholecystectomy, gastrectomy, and inguinal hernia operations, as well as clinical protocols for the surgical procedures, such as percutaneous transhepatic cholangiodrainage (PTCD) and percutaneous endoscopic gastrostomy (PEG). Health care is undergoing a challenging transition, and we must improve patient care and clinical practice.
authors.affiliation: Surgery for Organ Function and Biological Regulation, Nippon Medical School, Graduate School of Medicine. kiyama@nms.ac.jp
authors.forename: Teruo
authors.initials: T
authors.lastname: Kiyama
authors.forename: Takashi
authors.initials: T
authors.lastname: Tajiri
authors.forename: Toshiro
authors.initials: T
authors.lastname: Yoshiyuki
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Taniai
authors.forename: Eiji
authors.initials: E
authors.lastname: Uchida
authors.forename: Akira
authors.initials: A
authors.lastname: Tokunaga
mesh_terms: D019091:Critical Pathways; D039702:Current Procedural Terminology; D003953:Diagnosis-Related Groups / Q000191:economics*; D006782:Hospitals, Special / Q000191:economics / Q000706:statistics & numerical data; D006785:Hospitals, University / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007354:Insurance, Major Medical; D038801:International Classification of Diseases; D007564:Japan; D007902:Length of Stay / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians'; D011445:Prospective Payment System; D013514:Surgical Procedures, Operative / Q000145:classification / Q000191:economics / Q000592:standards*