Diabetes has become a growing concern in Japan, both medically and financially. The medical cost of diabetes was estimated at 1215 billion yen for fiscal year 2011. We analyzed the length of stay (LOS) in a hospital f...Diabetes has become a growing concern in Japan, both medically and financially. The medical cost of diabetes was estimated at 1215 billion yen for fiscal year 2011. We analyzed the length of stay (LOS) in a hospital for type 2 diabetes mellitus patients who participated in educational programs to determine factors affecting LOS. Data on 991 patients obtained from 28 Red Cross hospitals in 2008 were used. For the analysis, we used the Box-Cox transformation model and Hausman test. The results revealed that patients aged 75 years and above and those with comorbidities and complications were prone to longer LOS. The analysis also revealed significant differences in LOS across the hospitals, even after controlling for patient characteristics. Finally, we applied the least squares method to determine the effects of hospital and regional factors and revealed that patients’ LOS was affected by the region’s average LOS. Regional corporations and networks appeared to be important in improving educational programs.展开更多
Japanese medical expenditures have increased rapidly in recent years and are predicted to continue rising. Indeed, it remains uncertain whether the current Japanese medical system can be sustained. In this paper, we a...Japanese medical expenditures have increased rapidly in recent years and are predicted to continue rising. Indeed, it remains uncertain whether the current Japanese medical system can be sustained. In this paper, we analyzed the medical expenditures for educational hospitalization of patients with type 2 diabetes. A dataset of 6173 patients from 36 hospitals was used in the analysis. The sample period was from July 2008 to March 2012. We analyzed the medical expenditures in two ways. First, we analyzed the length of hospital stay (LOS). Next, we analyzed the daily expenditure per patient. The Box-Cox transformation model was used in the first analysis and the ordinary least squares method in the second. Comorbidities and complications prolonged LOS and increased daily expenditures. The LOS was significantly different among hospitals. On the other hand, the differences in daily expenditures among hospitals were relatively small, such that LOS was the main determinant of medical expenditures. Previous studies suggested that LOS could be shortened without degradation of medical quality. Moreover, LOS could be controlled by introducing proper critical paths and improving and standardizing educational programs. Hence, it would be possible to control the medical expenditures for this disease.展开更多
In this paper, we conducted a long term survey of the cataract surgeries. The sample period was about 7 years, from July 2005 to March 2012. We evaluated the effects of three revisions of the medical payment system th...In this paper, we conducted a long term survey of the cataract surgeries. The sample period was about 7 years, from July 2005 to March 2012. We evaluated the effects of three revisions of the medical payment system that were done in 2006, 2008 and 2010. For the analysis, the Box-Cox transformation model and Hausman test using Nawata’s estimator were used for the length of stay (LOS) in hospitals, and the ordinary least squares method was used for the non-inclusive (mainly payments for surgeries) payments. We analyzed a dataset of 51,054 patients obtained from 60 hospitals (Hp1-60) where more than 300 one-eye cataract surgeries were performed during the period. For the LOS, we found that only the 2008 revision had significant impact on shortening the LOS but the other two did not. We also found very large differences among hospitals even after eliminating effects of patients’ characteristics and type of principle diseases as previous studies. For non-inclusive payments 2006 and 2008 revisions had significant impacts and the differences among hospitals were much smaller than those of the LOS.展开更多
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 re...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.展开更多
This paper considers the asymptotic efficiency of the maximum likelihood estimator (MLE) for the Box-Cox transformation model with heteroscedastic disturbances. The MLE under the normality assumption (BC MLE) is a con...This paper considers the asymptotic efficiency of the maximum likelihood estimator (MLE) for the Box-Cox transformation model with heteroscedastic disturbances. The MLE under the normality assumption (BC MLE) is a consistent and asymptotically efficient estimator if the “small ” condition is satisfied and the number of parameters is finite. However, the BC MLE cannot be asymptotically efficient and its rate of convergence is slower than ordinal order when the number of parameters goes to infinity. Anew consistent estimator of order is proposed. One important implication of this study is that estimation methods should be carefully chosen when the model contains many parameters in actual empirical studies.展开更多
文摘Diabetes has become a growing concern in Japan, both medically and financially. The medical cost of diabetes was estimated at 1215 billion yen for fiscal year 2011. We analyzed the length of stay (LOS) in a hospital for type 2 diabetes mellitus patients who participated in educational programs to determine factors affecting LOS. Data on 991 patients obtained from 28 Red Cross hospitals in 2008 were used. For the analysis, we used the Box-Cox transformation model and Hausman test. The results revealed that patients aged 75 years and above and those with comorbidities and complications were prone to longer LOS. The analysis also revealed significant differences in LOS across the hospitals, even after controlling for patient characteristics. Finally, we applied the least squares method to determine the effects of hospital and regional factors and revealed that patients’ LOS was affected by the region’s average LOS. Regional corporations and networks appeared to be important in improving educational programs.
文摘Japanese medical expenditures have increased rapidly in recent years and are predicted to continue rising. Indeed, it remains uncertain whether the current Japanese medical system can be sustained. In this paper, we analyzed the medical expenditures for educational hospitalization of patients with type 2 diabetes. A dataset of 6173 patients from 36 hospitals was used in the analysis. The sample period was from July 2008 to March 2012. We analyzed the medical expenditures in two ways. First, we analyzed the length of hospital stay (LOS). Next, we analyzed the daily expenditure per patient. The Box-Cox transformation model was used in the first analysis and the ordinary least squares method in the second. Comorbidities and complications prolonged LOS and increased daily expenditures. The LOS was significantly different among hospitals. On the other hand, the differences in daily expenditures among hospitals were relatively small, such that LOS was the main determinant of medical expenditures. Previous studies suggested that LOS could be shortened without degradation of medical quality. Moreover, LOS could be controlled by introducing proper critical paths and improving and standardizing educational programs. Hence, it would be possible to control the medical expenditures for this disease.
文摘In this paper, we conducted a long term survey of the cataract surgeries. The sample period was about 7 years, from July 2005 to March 2012. We evaluated the effects of three revisions of the medical payment system that were done in 2006, 2008 and 2010. For the analysis, the Box-Cox transformation model and Hausman test using Nawata’s estimator were used for the length of stay (LOS) in hospitals, and the ordinary least squares method was used for the non-inclusive (mainly payments for surgeries) payments. We analyzed a dataset of 51,054 patients obtained from 60 hospitals (Hp1-60) where more than 300 one-eye cataract surgeries were performed during the period. For the LOS, we found that only the 2008 revision had significant impact on shortening the LOS but the other two did not. We also found very large differences among hospitals even after eliminating effects of patients’ characteristics and type of principle diseases as previous studies. For non-inclusive payments 2006 and 2008 revisions had significant impacts and the differences among hospitals were much smaller than those of the LOS.
文摘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.
文摘This paper considers the asymptotic efficiency of the maximum likelihood estimator (MLE) for the Box-Cox transformation model with heteroscedastic disturbances. The MLE under the normality assumption (BC MLE) is a consistent and asymptotically efficient estimator if the “small ” condition is satisfied and the number of parameters is finite. However, the BC MLE cannot be asymptotically efficient and its rate of convergence is slower than ordinal order when the number of parameters goes to infinity. Anew consistent estimator of order is proposed. One important implication of this study is that estimation methods should be carefully chosen when the model contains many parameters in actual empirical studies.
