Functional mapping of hospitals by diagnosis-dominant case-mix analysis.
BACKGROUND
Principles and methods for the allocation of healthcare resources among healthcare providers have long been health policy research issues in many countries. Healthcare reforms including the development of a new case-mix system, Diagnosis Procedure Combination (DPC), and the introduction of a DPC-based payment system are currently underway in Japan, and a methodology for adequately assessing the functions of healthcare providers is needed to determine healthcare resource allocations.


METHODS
By two-dimensional mapping of the rarity and complexity of diagnoses for patients receiving treatment, we were able to quantitatively demonstrate differences in the functions of different healthcare service provider groups.


RESULTS
On average, inpatients had diseases that were 3.6-times rarer than those seen in outpatients, while major teaching hospitals treated inpatients with diseases 3.0-times rarer on average than those seen at small hospitals.


CONCLUSIONS
We created and evaluated a new indicator for DPC, the diagnosis-dominant case-mix system developed in Japan, whereby the system was used to assess the functions of healthcare service providers. The results suggest that it is possible to apply the case-mix system to the integrated evaluation of outpatient and inpatient healthcare services and to the appropriate allocation of healthcare resources among health service providers.
Fushimi
Kiyohide
K
Department of Health Care Informatics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan. kfushimi.hci@tmd.ac.jp
Hashimoto
Hideki
H
Imanaka
Yuichi
Y
Kuwabara
Kazuaki
K
Horiguchi
Hiromasa
H
Ishikawa
Kohichi B
KB
Matsuda
Shinya
S
D017046:Cost Savings; D003953:Diagnosis-Related Groups / Q000191:economics* / Q000706:statistics & numerical data; D004469:Economics, Hospital / Q000639:trends; D004470:Economics, Medical; D005260:Female; D018166:Health Care Reform / Q000379:methods*; D006295:Health Resources / Q000706:statistics & numerical data / Q000600:supply & distribution*; D006302:Health Services Research; D017721:Hospital Costs; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007564:Japan; D008297:Male; D017063:Outcome Assessment, Health Care; D011445:Prospective Payment System / Q000592:standards* / Q000639:trends; D040841:Resource Allocation / Q000379:methods; D013038:Specialization