Evaluation of Inclusive Payment System Based on DPC for Cataract Surgeries

概要

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In this paper, we evaluated the inclusive payment system based on the DPC (Diagnosis Procedure Combination) for cataract surgeries (DPC Category Code: 020110). We utilized the data pertaining to 1,225 patients hospitalized for cataracts and underwent lens operations from July 2004 to September 2005. The data were collected by the DPC Hospital Conference. We found large differences in the length of stay and payment based on the DPC among hospitals despite eliminating the influence of characteristics of patients, names of main diseases, presences of secondary diseases and treatments. The highest average payment based on the DPC was 3.5 times as high as the lowest payment. On the other hand, differences in payments based on the fee-for-service among hospitals were relatively small. The largest deviation from the average of all hospitals was about 10%. As the results, the major differences of medical payments by hospitals were payments based on the DPC, which accounted for only one-third of the total medical payments for this disease. The results of the study strongly suggest that the characteristics of the disease must be considered for efficient use of medical resources in the future revision of the payment system.
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