The effect of separating from the medical work consignment in a municipal hospital

Abstract

Matsusaka city hospital, which has 328 beds and is run under the Local Public Enterprise Law, introduced DPC/PDPS （Diagnosis Procedure Combination/Per-Diem Payment System；DPC/PDPS） reimbursement system in April 2008. Owing to the consciousness reform in the stuff, we improved management and succeeded in overcoming the deficit since 1989. To improve further the management, General Planning Office under direct supervision of the director was opened in April 2010. Here we report on the effect of breaking away from the medical work consignment.

Municipal hospitals expend a lot in commission fees；of these, the fee of medical practice is particularly high. Our hospital requires 140 million yens per year as medical expenses. We evaluated the degree of staff motivation and cuts in cost after executing direct management.

Before direct management, we employed 6 persons from the city and 50.5 persons from a contractor. Since the change to direct management, the number of employees was 9 as a full time and 48 as part-time. As a consequence, the total cost decreased by 30 millions, and there was a great improvement in the personnel motivation, much work in specialized areas, much more flexibility in the work and much more awareness in the staffs. The health information manager employs a total of 14 people, including a director of nursing, nurses, and our hospital is committed to improve on management.