Medical Fee Simulation of the Diagnosis Procedure Combination System Using Clinical Pathways

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  • クリニカルパスを利用したDPCシミュレーション
  • クリニカルパス オ リヨウ シタ DPC シミュレーション

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<p>　With the introduction of the prospective payment system, called the diagnosjs procedure combination (DPC) system, due consideration of the changes in medical fees and how to deal with them has become necessary at our hospital. For this reason, changes in medical fees were simulated for 36 clinical pathways and their 334 applicable clinical cases. Then the medical fee for the treatment of each of them was calculated according to the DPC system and the current payment system. The two systems were then compared. The projected treatment fees and the many factors impacting on them were investigated, including costs of medication injections, laboratory tests, examinations and imaging diagnostics.</p><p>　The total fees were estimated to increase 4 to 6 percent when calculated using the new DPC system, and this estimation was confirmed with actual clinical results 9 months after the introduction of the DPC system. Total fees under the DPC system relatively decreased in cases in which there were many orders placed for medicine, examinations and radiography. The length of hospitalization and surgical operations showed no clear relationship with the changes in medical fees. ln some pathways, a shortening of hospitalization showed a tendency to reduce the medical fees.</p><p>　Clinical pathways are useful not only for medical quality improvement but also as an effective tool for the simulation of medical treatment fees. Moreover, by creating more clinical pathways for many more diseases, the standardization of treatments may thereby progress, making it possible to cope more effectively with ongoing changes in the medical fee system.</p>

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