抄録
The estimation of medical expenses based on disease structure is necessary to improve the efficiency of the health care delivery system and to maintain the social health insurance system in Japan in the face of the rapid aging of the population which is anticipated in the near future. Our aim is to estimate regional needs for health care services by using a national patient database in conjunction with the diagnosis procedure combination (DPC) patient classification system. A data warehouse was constructed with dimensions including year, regions, DPC disease classification, and provider attributes, and then subjected to OLAP analyses. Needs for health care services in the designated medical service areas were estimated from disease structure in the districts and the average health service utilization for relevant DPC groups, as determined from DPC claim data. Actual needs for acute care hospital beds were estimated from disease structure in the districts, and revealed a large excess of acute care beds in most of areas. Admissions of patients to hospitals in medical service areas different from those for patients' residences were quantitatively determined for each of the DPC groups. It was found that patients requiring cardiac surgeries traveled farther than those with other diseases to reach hospitals conducting a large volume of such surgeries. Our results indicated the feasibility and the effectiveness of the arrangement of regional health care delivery plans based on the DPC case mix system and national patient database.
