Influence and provision for comprehensive insurance system--digestive surgery

The diagnostic procedure combination (DPC) was introduced in 82 institutions from April 2003. DPC is similar to the diagnosis-related group and prospective payment system, which is widely used in the USA. The payment of DPC is calculated by multiplying the cost/day in each DPC, hospital stay in days, and index of each hospital, which is determined by several variables including the mean hospital stay in the previous year. After the introduction of DPC, clinical and diagnostic examinations, and cancer chemotherapy were shifted from the inpatient to outpatient setting in our institution, as well as in most of the other institutions reported by the Ministry of Health, Labor and Welfare. Because of the examinations in the outpatient clinic, the preoperative hospital stay was shortened. To validate the safety and effectiveness of cancer chemotherapy in the outpatient clinic, a central system was established in our institution by unifying the protocols and limiting the maximum administered doses by computer. After introduction of DPC, the average hospital stay was shortened in most institutions including ours. In spite of the satisfaction of the patients surveyed, the benefits of DPC should be confirmed based on the final outcome in terms of clinical therapeutic results.