Yoshio Mitsumori07.20.06
The Ministry of Health, Labor & Welfare (MHLW) also announced its intention to expand the Bundled Payment System, also called DPC (Diagnosis Procedure Combination), to 360 qualified institutions within fiscal 2006, which is about 2.5 times as much as today. The projected expansion may include 190,000 beds nationwide, which is about 20% of total hospital beds.
To provide a little background, general medical remuneration has been historically made by the “Cost Reimbursement System.” However, in 2003, the current DPC system was implemented on a trial basis at a limited number of university hospitals and national hospitals. The DPC system differentiates diseases to 3,074 kinds in accordance with IDC-10 and fixes the remuneration per diem by disease.
According to a surveillance report by the DPC evaluation subcommittee, the average length of stay at DPC hospitals decreased from 19.13 days in 2004 to 18.26 days in 2005. The report concluded that DPC hospitals are mostly appreciated as a core acute care institution in each district, and the DPC has not had a negative impact on the medical services. On the contrary, however, a few hospitals have seen a slight increase in the re-admission rate. The subcommittee has kept a watchful eye on the re-admission rate in an attempt to grasp the real situation occurring at such institutions.
Some data show that DPC hospitals earn more than non-DPC general hospitals. In 2004, the revenue growth at non-DPC general hospitals remained 1.3%, whereas DPC hospitals increased 2.4%. This is because DPC hospitals tried to shorten the length of stay per admission and take in more acute patients. Ironically, the DPC system has not depressed the medical expenditure but rather increased it. Nevertheless, the major portion of outpatient services and surgical fees—including medical devices—remain in the “Cost Reimbursement System,” even in DPC hospitals. This is quite different from the US DRG system. Consequently, the effect of the current DPC has been questioned in terms of whether it may really contribute to the smaller expenditure for the future.
The high level discussion will be continued among leaders from relevant concerned sectors.