Methods Inf Med 2007; 46(06): 679-685
DOI: 10.1055/s-0038-1625428
Original Article
Schattauer GmbH

Development of Hospital Data Warehouse for Cost Analysis of DPC Based on Medical Costs

F. Muranaga
1   Department of Medical Informatics, Kagoshima University Hospital, Kagoshima City, Japan
,
I. Kumamoto
2   2Department of Medical Information Sciences, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima City, Japan
,
Y. Uto
2   2Department of Medical Information Sciences, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima City, Japan
› Author Affiliations
Further Information

Publication History

Publication Date:
12 January 2018 (online)

Summary

Objectives : To develop a data warehouse system for cost analysis, based on the categories of the diagnosis procedure combination (DPC) system, in which medical costs were estimated by DPC category and factors influencing the balance between costs and fees.

Methods : We developed a data warehouse system for cost analysis using data from the hospital central data warehouse system. The balance data of patients who were discharged from Kagoshima University Hospital from April 2003 to March 2005 were determined in terms of medical procedure, cost per day and patient admission in order to conduct a drill-down analysis. To evaluate this system, we analyzed cash flow by DPC category of patients who were categorized as having malignanttumors andwhose DPC category was reevaluated in 2004.

Results : The percentages of medical expenses were highest in patients with acute leukemia, non-Hodgkin's lymphoma, and particularly in patients with malignant tumors of the liver and intrahepatic bile duct. Imaging tests degraded the percentages of medical expenses in Kagoshima University Hospital.

Conclusions : These results suggested that cost analysis by patient is important for hospital administration in the inclusive evaluation system using a case-mix index such as DPC.

 
  • References

  • 1. Fischer WA. comparison of PCS construction principles of the American DRGs, the Australian system, and the German FP/SE system. Casemix 2000; 2 (01) 12-20.
  • 2. Woodbury MA, Manton KG. Anew procedure for analysis of medical classifications. Methods Inf Med 1982; 21 (04) 210-220.
  • 3. Fetter RB, Shin Y, Freeman JL. et al. Case mix definition by diagnosis-related groups. Medical Care 1980; 18 (Suppl. 02) 1-53.
  • 4. Davis C, Rhodes DJ. The impact of DRGs on the cost and quality of health care in the United States. Health Policy 1988; 9 (02) 117-131.
  • 5. Kahn KL, Keeler EB, Sherwood MJ. et al. Comparing outcomes of care before and after implementation of the DRG-basedprospective payment system. JAMA 1990; 264 (15) 1984-1988.
  • 6. Matsuda S. Health Insurance System in Japan. Journal d’economie medicale 2004; 22 (01) 2 15-26.
  • 7. Matsuda S. The historical analysis of Japanese fee schedule in the social health insurance. Journal d’ economie medicale 2004; 22 (01) 2 27-38.
  • 8. Matsuda S. Re-organization of the Japanese hospital system. Journal d’economie medicale 2004; 22 (01) 2 69-78.
  • 9. Cao P, Toyabe S, Kurashima S, Okada M, Akazawa K. A Modified Method of Activity-based Costing for Objectively Reducing Cost Drivers in Hospital. Methods Inf Med 2006; 45: 462-469.
  • 10. Koyama W. Lifestyle change improves individual health and lowers healthcare costs. Methods Inf Med 2000; 39 (229) 232.
  • 11. Ishikawa KB, Holt M, Kaihara S, Yoshikawa A, Hopkins DS, Mason M. Performance, characteristics, and case mix in Japanese and American teaching hospitals. Medical Care 1993; 31 (06) 542-551.
  • 12. Fushimi K, Hashimoto H, Imanaka Y, Kuwabata K, Horiguchi H, Ishikawa K, Matsuda S. Refinement of DPC classification facilitated by OLAP analysis of patient profiles and medical procedures. Proceedings of the 20th conference of PCS/E 2004; 395-402.
  • 13. Kuwabara K, Imanaka Y, Matsuda S, Fushimi K, Hashimoto H, Ishikawa KB, Horiguchi H. Profiling of resource use variation among six diseases treated at 82 Japanese special functioning hospitals, based on administrative data. Health Policy 2006; 78 (02) 3 306-318.
  • 14. Fushimi K, Hashimoto H, Imanaka Y, Kuwabara K, Horiguchi H, Ishikawa KB, Matsuda S. Functional mapping of hospitals by diagnosis-dominant case-mix analysis. BMC Health Serv Res 2007; 7: 50.
  • 15. Uto Y, Kumamoto I. Study on weighting of amount ofnursing care using data on index of patient’s need for nursing and system approach. Journal of Medical Systems 2005; 29 (02) 165-177.
  • 16. Yasunaga H, Ide H, Imamura T, Ohe K. Influence of Japan’s new Diagnosis Procedure Combination-based payment system on the surgical sector: does it really shorten the hospital stay?. Surg Today 2006; 36 (07) 577-585.
  • 17. Yasunaga H, Ide H, Imamura T, Ohe K. Impact of the Japanese Diagnosis Procedure Combination-based Payment System on cardiovascular medicine related costs. International Heart Journal 2005; 46 (05) 855-866.