[Case mix based payment and DPC from an international perspective].

Area of Science:

• Health Economics
• Healthcare Management
• Medical Informatics

Context:

• Diagnosis Related Groups (DRG) originated in the US for Medicare hospital payments.
• Japan adopted a Diagnosis Procedure Combination (DPC)-based reimbursement system.
• The Japanese DPC system combines a DPC component with Fee-For-Service (FFS).

Purpose:

• To enhance transparency in Japanese hospital activities.
• To establish measurable hospital services for policy discussions.
• To support a sustainable Japanese healthcare system.

Summary:

• The Japanese DPC system classifies patients using diagnosis and procedures.
• The DPC component covers basic hospital charges, ward supplies, and minor procedures.
• The FFS component covers major surgical procedures and expensive supplies.

Impact:

• Refinement of DPC version 3 is crucial for reliability.
• Development of a Co-morbidity-Complication-Procedure (CCP) matrix is underway.
• Accurate evaluation of nursing, ICU, and high-cost items within DPC is needed.