title: Has the Reform of the Japanese Healthcare Provision System Improved the Value in Healthcare? A Cost-Consequence Analysis of Organized Care for Hip Fracture Patients.
abstract: OBJECTIVE
  To assess the value of organized care by comparing the clinical outcomes and healthcare expenditure between the conventional Japanese "integrated care across specialties within one hospital" mode of providing healthcare and the prospective approach of "organized care across separate facilities within a community".
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Two groups of hospitals were categorized according to healthcare delivery approach: the first group included 3 hospitals autonomously providing integrated care across specialties, and the second group included 4 acute care hospitals and 7 rehabilitative care hospitals providing organized care across separate facilities.
  
  
  METHODS
  Patients aged 65 years and above who had undergone hip fracture surgery.
  
  
  METHODS
  Regression models adjusting for patient characteristics and clinical variables were used to investigate the impact of organized care on the improvements to the mobility capability of patients before and after hospitalization and the differences in healthcare resource utilization.
  
  
  RESULTS
  The sample for analysis included 837 hip fracture surgery cases. The proportion of patients with either unchanged or improved mobility capability was not statistically associated with the healthcare delivery approaches. Total adjusted mean healthcare expenditure for integrated care and organized care were US$28,360 (95% confidence interval: 27,787-28,972) and US$21,951 (21,511-22,420), respectively, indicating an average increase of US$6,409 in organized care.
  
  
  CONCLUSIONS
  Our cost-consequence analysis underscores the need to further investigate the actual contribution of organized care to the provision of efficient and high-quality healthcare.
authors.affiliation: Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Haruhisa
authors.initials: H
authors.lastname: Fukuda
authors.affiliation: Institute for Health Economics and Policy, Tokyo, Japan.
authors.forename: Sayuri
authors.initials: S
authors.lastname: Shimizu
authors.affiliation: Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.
authors.forename: Tatsuro
authors.initials: T
authors.lastname: Ishizaki
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003695:Delivery of Health Care; D019033:Delivery of Health Care, Integrated; D005260:Female; D017048:Health Care Costs; D006620:Hip Fractures / Q000453:epidemiology*; D006761:Hospitals; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D017063:Outcome Assessment, Health Care; D010342:Patient Acceptance of Health Care; D012189:Retrospective Studies