J.Jpn. Surg. Soc.. 106(10): 654-658, 2005

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Feature topic

EFFECTS AND MEASURES OF THE FLAT PAYMENT SYSTEM BASED ON THE DIAGNOSIS PROCEDURE COMBINATION SYSTEM IN PEDIATRIC SURGERY

The current status of the flat payment system based on the diagnosis procedure combination (DPC) system was examined in pediatric surgery. Many important diseases especially in neonatal surgery are not listed for the DPC system due to either the small number of cases or variations in hospital stay or cost. In our university hospital, however, the DPC system was applied to 286 (90.8%) of 315 admissions. Total scores for the admissions were slightly higher (103.5%) in the DPC system compared with the fee-for-service system. Scores for inguinal hernia by day surgery and one-night stay were also slightly higher (102.2%) in the DPC system.
Future measures for the DPC system include the provision that most preoperative evaluations should be performed in outpatient clinics and further elective surgery at a separate admission is recommended for patients with benign disease or in good condition. In cases of surgery for emergencies or malignancies, too many examinations should be avoided. Postoperative treatment using a clinical path without complications should be performed to achieve shortening of hospital stays and reduced cost.
Problems in the current DPC system are complicated and inadequate classification, probably due to the unique and cost-unbeneficial nature of pediatric surgery. To establish a better medical fee system, further efforts to improve the DPC system should be continued.

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