著者

鈴田 祐介

出版者

日本経営学会

雑誌

日本経営学会誌 (ISSN:18820271)

巻号頁・発行日

vol.47, pp.74-86, 2021 (Released:2022-09-21)

参考文献数

34

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In Japan, the Diagnosis Procedure Combination / Per-Diem Payment System (DPC / PDPS) has been introduced into most hospitals providing hyperacute and acute care. Given that background, the study described herein specifically examined the amount of change in hospitalization revenues related to the effects of official price revision, which are fundamentally undertaken once every two years. Conventional approaches used for earlier studies of medical practice revenues used patient-level data because personal attributes of patients and treatments administered to patients are distinguished. By contrast, this study adopts hospital-level data directed by DPC and estimates effects of official price revision more simply. For development of a theoretical model, two-step least squares (2SLS) was applied with two years as one period, referring to the method of factor analysis of medical expense variation. In first-stage analysis, to add effects of official price revision, “the estimator of mean of hospitalization revenue during the earlier period of the official price revision” was calculated and added as a proxy variable to an explanatory variable in the second-stage theoretical model. To analyze the DPC participating hospitals and DPC preparatory hospitals, Ministry of International Affiliates and Communications data for local government hospitals during 2010–2017 and Ministry of Health, Labor and Welfare data were matched for verification. The following results were obtained. First was that an appropriate coefficient was estimated for the rate of change in “hospitalization revenue” for the effect of official price revision. During 2012–2017, the revision had almost curbed medical expenses to “0” in local government hospitals. Secondly, results obtained using hospital unit data show that the rate of change in “hospitalization revenue” in the official price revision years increased slightly in a more positive direction than in the subsequent year. One can infer that this result is attributable to local government hospital management efforts.