RESOURCE UTILIZATION OF GASTRIC CANCER PATIENTS AGGREGATED ITEM-BY-ITEM AND COMPARISON OF THE MEDICAL COSTS WITH THE REIMBURSEMENT LEVEL AND LENGTH OF HOSPITAL STAY

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  • IIJIMA Sachiko
    Department of Public Health, Graduate School of Medicine, The University of Tokyo Mitsui Memorial Hospital
  • FUKUDA Takashi
    Department of Pharmacoeconomics, Graduate School of Pharmaceutical Sciences, The University of Tokyo
  • KOBAYASI Yasuki
    Department of Public Health, Graduate School of Medicine, The University of Tokyo
  • TAMURA Yutaka
    Tamura Clinic, (Formerly, International Medical Center of Japan)

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  • 診療行為別原価計算に基づく胃がん症例の原価算出と在院日数・診療報酬との比較
  • シンリョウ コウイ ベツ ゲンカ ケイサン ニ モトヅク イ ガン ショウレイ ノ ゲンカ サンシュツ ト ザイイン ニッスウ シンリョウ ホウシュウ ト ノ ヒカク

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Objective Using the new hospital cost accounting method per case based on cost per service, we compared the medical costs with the reimbursement level and length of hospital stay for gastric cancer patients.<br/>Method The subjects were 158 gastric cancer patients who were admitted for surgery in a public hospital in Tokyo between 1995 and 1997. The new cost accounting method that we developed according to the activity-based costing method was applied in the following four levels; major items of expenditure for the hospital; costs incurred in each department; costs per medical service units; and costs of all the services per case.<br/>Results 1) 158 patients were studied. All the cost figures are adjusted to those in the 1998 fiscal year. The mean length of stay (LOS) of the 158 cases were 52±16 days. The average charge was 1,835,000 yen, and the average costs was 2,034,000 yen.<br/> 2) The per capita ratio of charge to cost (RCC) was 0.90. RCC for medications, procedure treatments, laboratory tests, and medical management/accommodation were 1.04, 1.44, 1.35, and 0.31, respectively.<br/> 3) The peason's correlation coefficient between the total costs and LOS was 0.80 (P<0.001). A high correlation was noted for costs for medical management/accommodation and nursing with LOS (r=0.98, P<0.001; r=0.97, P<0.001; respectively), while that for cost for operations was low (r=0.03, P>0.05).<br/> The partial correlation coefficient between the total costs and the total charges with the LOS adjustment was 0.58 (P<0.001). The coefficient for costs and charges for medications and procedure were high (r=0.99, P<0.001; r=1.00, P<0.001), while that for medical management/accommodation was low (r=0.16, P<0.001).<br/>Conclusions LOS reflected the cost for room and nursing, but not the resource consumption for medical treatment per case. While the present fee schedules overestimate the costs of medication and laboratory tests, they underestimate those for medical management/accommodation. LOS and charges did not correctly reflect the medical costs per case.

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