Functional mapping of hospitals by diagnosis-dominant case-mix analysis

BMC Health Serv Res. 2007 Apr 10:7:50. doi: 10.1186/1472-6963-7-50.

Abstract

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.

Conclusion: 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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cost Savings
  • Diagnosis-Related Groups / economics*
  • Diagnosis-Related Groups / statistics & numerical data
  • Economics, Hospital / trends
  • Economics, Medical
  • Female
  • Health Care Reform / methods*
  • Health Resources / statistics & numerical data
  • Health Resources / supply & distribution*
  • Health Services Research
  • Hospital Costs
  • Hospitals / statistics & numerical data*
  • Humans
  • Japan
  • Male
  • Outcome Assessment, Health Care*
  • Prospective Payment System / standards*
  • Prospective Payment System / trends
  • Resource Allocation / methods
  • Specialization