An Econometric Analysis of Hospital Length of Stay for Cataract Operations in Japan by the Box-Cox Transformation Model and Hausman Tests: Evaluation of the 2010 Revision of the Medical Payment System*

摘要

The Japanese medical costs for cataract treatments reached 270 billion yen in fiscal year 2012. Since the length of stay (LOS) in hospital is much longer than other major countries, controlling the medical costs by reducing LOS becomes an important issue in Japan. In this paper, we evaluated the effects of the 2010 revision of the Japanese medical payment system (DPC/PDPS) on LOS for cataract operations. The Box-Cox transformation model, Nawata’s estimators and Hausman tests were used in the analysis. To evaluate the effects, we analyzed a dataset obtained from 34 DPC hospitals (Hp1-34) where one-eye cataract operations were performed both before (April 2008-March 2010) and after (April 2010-March 2012) the 2010 revision and there were more than 500 patients. The dataset contained information from 32,593 patients. We did not admit the effect of the 2010 revision in this study, and there were large differences LOS among hospitals, even after removing the influences of factors such as patient characteristics and types of principal diseases.