2014 Volume 15 Issue 3 Pages 197-202
Aging of the population, which will progress rapidly into 2025, is one of social problems in Japan. Specifically, medical care cost is expected to further escalate. In order to maintain universal health care system, it is important to streamline medical resources while securing necessary medical services. In Saga University Hospital, the number of the elderly is also increasing, and ischemic heart disease is one of the most frequently occurring diseases. In this study, based on the difference in surgery of ischemic heart disease in our hospital, the authors investigated the current situation of mortality rate, the number of hospitalizations, total length of stay and total medical bills, and discussed measures to make medical bills more reasonable.
Patients with ischemic heart disease in our hospital between July 2008 and August 2013 were extracted and classified into two groups：patients who underwent percutaneous coronary intervention (PCI group) and patients who underwent coronary artery bypass grafting (CABG group). In addition, PCI group was divided into three subgroups based on the frequency of PCI：once (PCI-1), twice (PCI-2), and three times or more (PCI-3+).
Compared with PCI group, CABG group had longer length of stay and higher medical bills. Between PCI-3+ group and CABG group, there was no significant difference in mortality rate, length of stay or medical bills.
The results suggest that if mortality rate is used as an index of securing necessary medical services, PCI is better than CABG in terms of length of stay and medical bills. However, in the cases where PCI was performed three times or more, there was no difference in efficiency. Therefore, not to investigate difference in operative procedure but to cooperate with backup hospitals and to improve home medical care will be a more effective measures to streamline medical resources.
