title: Development and analysis of a nationwide cost database of acute-care hospitals in Japan.
abstract: OBJECTIVE
  Understanding of hospital cost is crucial to achieve an ideal balance between the assurance and improvement of patient safety and quality, and efficient use of finite resources. However, neither a standardized calculation methodology nor a large-scale database of costs in acute-care hospitals exists in Japan. This study aims to develop a standardized methodology, construct a nationwide cost database in Japan, analyse the characteristics of the database and examine the relationship between the cost and the charge from the viewpoint of an appropriate reflection of the cost to the price.
  
  
  METHODS
  We designed the costing framework, gathered the data for patients discharged from 139 acute-care hospitals in Japan between July 2004 and October 2004 and constructed a database containing information on 284,730 patients. The characteristics of the database and the relationship between the cost and the charge were investigated.
  
  
  RESULTS
  In the nationwide database we constructed, a wide range in the average cost per hospitalization and average cost per diem was observed. A wide variation of cost components was seen across major diagnostic categories. Moreover, there was a high correlation between the cost and the charge (Correlation coefficient = 0.94).
  
  
  CONCLUSIONS
  After designing a costing framework, a nationwide database comprised of individual case-level costs with components for acute-care hospitals in Japan was successfully developed. We hope this study contributes to appropriate decision making and helps motivate further research geared towards efficient hospital management and a rational payment system in Japan.
authors.affiliation: Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Kenshi
authors.initials: K
authors.lastname: Hayashida
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Imanaka
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Otsubo
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Kuwabara
authors.forename: Kohicih B
authors.initials: KB
authors.lastname: Ishikawa
authors.forename: Kiyohide
authors.initials: K
authors.lastname: Fushimi
authors.forename: Hideki
authors.initials: H
authors.lastname: Hashimoto
authors.forename: Hideo
authors.initials: H
authors.lastname: Yasunaga
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Horiguchi
authors.forename: Makoto
authors.initials: M
authors.lastname: Anan
authors.forename: Kenji
authors.initials: K
authors.lastname: Fujimori
authors.forename: Shunya
authors.initials: S
authors.lastname: Ikeda
authors.forename: Shinya
authors.initials: S
authors.lastname: Matsuda
mesh_terms: D003365:Costs and Cost Analysis / Q000592:standards*; D016208:Databases, Factual / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000191:economics*; D005102:Health Expenditures / Q000639:trends*; D017722:Hospital Charges / Q000706:statistics & numerical data; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D007564:Japan; D016730:Program Development