Changes in Referral Rates After the Mandate of Charging Additional Fees for Non-referral First Visits: A Controlled...

Area of Science:

• Health policy
• Healthcare economics
• Hospital management

Background:

• Japan implemented fees for non-referral first visits in higher-level hospitals starting April 2016.
• The policy aimed to differentiate hospital functions and was gradually expanded to more hospitals based on bed size.
• This study examines the impact of these fees on patient referral rates.

Purpose of the Study:

• To investigate the effect of mandated fees for non-referral first visits on hospital referral rates in Japan.
• To analyze changes in referral proportions before and after the policy implementation across different hospital categories.

Main Methods:

• Utilized a Japanese community-based insurance claims database (April 2014-March 2022).
• Calculated monthly referral rates for hospitals with ≥ 200 beds, categorized by hospital type and size.
• Employed a controlled interrupted time-series analysis, using non-designated hospitals as controls.

Main Results:

• Referral rates to Special Functioning Hospitals (SFHs) remained high and unchanged.
• Referral rates to Regional Medical Care Support Hospitals (RMCSHs) with ≥ 500 beds increased by 5.10% in 2016.
• Referral rates to RMCSHs with 400-499 beds increased by 4.49% in 2018; no change was observed for RMCSHs with 200-399 beds.

Conclusions:

• Mandating additional fees for non-referral first visits increased referral rates for RMCSHs with ≥ 400 beds.
• The policy's impact on overall health outcomes requires further investigation.