Importance of care process management in terms of financial perspective：based on knowledge of hospital managers

Abstract

Relationships between clinical process and cost/profitability are inferred from a questionnaire survey to hospital managers. This survey was mailed to 1,585 acute care hospitals reimbursed by DPC/PDPS (Diagnosis Procedure Combination/Per-Diem Payment System), and response rate was 16.7%. It reveals that managers suppose the following four relationships：within the same DPC, cases with irregularly longer length of stay (LOS) are more expensive and unprofitable than cases with standard LOS；DPCs with considerable variation of LOS are more unprofitable than DPCs with small variation；within the same DPC with critical pathway, cases deviated from the pathway are more expensive and unprofitable than cases on the pathway；and cases of DPCs without critical pathway are more unprofitable than cases of DPCs with pathway. These results indicate that controlling clinical process with standardized protocol such as critical pathway is important for profitability management. In addition, these results infer the need of modifying medical reimbursement system to prevent hospitals which face a severe financial pressure from excessive profitability management. Since possible relationships between clinical process and cost/profitability are not empirically supported by financial evidence based on cost accounting, further study to verify managers' knowledge is needed.