[Development of the reimbursement system based on DPC].
In the health insurance system of Japan, a fee-for-service system has been applied to individual treatment services, but this fee system involves a structural problem of causing increases in examinations and drug administration. Various attempts have been made to solve this structural problem in several treatment fields, in which a flat payment system can be introduced with the fee for-service system as the basis. The diagnosis procedure combination (DPC) system introduced in April 2003, which is a flat payment system using a diagnosis classification, is the first large scale revision of the medical fee system of Japan. This diagnosis classification is considered to be effective for simplifying the medical fee system, within the framework of EBM, and for providing patients with information. However, since there are also structural problems in the flat payment system, such as examination and treatment of low quality, selection of patients, and upcoding, its introduction should be performed with sufficient caution. We will make more efforts to establish a better medical fee system by evaluating these problems.
Nakamura
Kenji
K
Medical Economics Division, Health Insurance Bureau, Ministry of Health, Labour and Welfare, Chiyoda-ku, Tokyo 100-8916.
D003953:Diagnosis-Related Groups / Q000191:economics*; D018588:Fee-for-Service Plans / Q000191:economics; D007349:Insurance, Health, Reimbursement / Q000191:economics*; D007564:Japan