Short Info: DPC (Japan)

In Japan in 2003, DPCs containing 2'552 patient categories were introduced as a payment instrument for 80 academic hospitals and two special hospitals.1 In 2005, the DPC system comprised 2'335 patient categories.2 Classification criteria were: principal diagnosis with secondary diagnoses, as well as the most resource-intensive procedure. The system is structured according to 1860 diagnoses (ICD-10), 475 diseases and 16 main categories.

Payment to hospitals consists of a DPC-payment plus reimbursements for selected individual services. The DPC-amount is called "hospital's fee". It is paid by daily lump sums: These covers accommodation services, examinations, supplies used in the wards, as well as interventions that cost less than 10,000 ¥ (approx. 85 USD). Fees for services ("doctor's fee") include all interventions that cost more than 10,000 ¥, as well as drugs and supplies used in surgical operations.3

The number of daily points per DPC is separately defined for three different time stages:4

• Stage 1 lasts up to the first quartile of the length of stay. For this purpose, daily DPC-points are calculated as 115 % of the average DPC cost weight.
• Stage 2 lasts from the first quartile to the expected average length of stay. In this stage, the average remaining number of points is used as cost weight which is calculated as difference between the ‹DPC daily cost weight multiplied by the expected average duration of stay› and the ‹daily DPC cost weight increased by 15 %, and multiplied by the first quartile of the duration of stay›.
• In the following stage 3 (which comes after the expected average length of stay), 85 % of the daily points of stage 2 are charged.
• For days longer than the average plus the double standard deviation of length of stay, fee for service is payed.

The so calculated DPC points are multiplied by hospital specific coefficient, and by a base rate (of 10 ¥ per DPC point).