2016 Volume 17 Issue 3 Pages 117-122
Due to the progress of medical functional differentiation as medical policies, large hospitals have been required to reduce and specialize outpatient functions and to concentrate on inpatient medical care. However, no progress has been achieved in this regard.
The purpose of this study was to investigate the reduction in outpatient sections, which is regarded as a part of hospital functional differentiation, and the influence of the functions of large hospitals and regional medical systems on the reduction of patient consultation for mild symptoms in the outpatient sections of large hospitals.
The subjects were 82 large national hospitals with 200 or more general beds during a period from April 2013 to March 2014. Diagnosis Procedure Combination (DPC) and outpatient claim data from the hospitals were analyzed. First, patients with mild symptoms were identified and the patient consultation situation was clarified. Next, multiple regression analysis was conducted to investigate the proportion of patient consultations, and hospital and regional medical system factors. In addition, patients with mild symptoms were defined as those who received possible medical care at clinics. We developed an evaluation method using outpatient claim data.
The proportion of the patients with mild symptoms visiting the hospitals was 38.12% (SD＝9.2%). Factors that influenced consultations included chemotherapy rate （β＝-0.55，p＜0.01）, surgical rate （β＝-0.41，p＜0.01）, efficiency index （β＝-0.25，p＜0.02）, and general beds ＞ other beds （β＝-0.22，p＜0.02）. In this model, R２ ＝ 0.56. These variables indicate the quantity of acute-stage medical care, where higher values indicate lower consultation rates.
This study indicated that hospital functional differentiation can be promoted by decreasing the number of patient consultations for mild symptoms, which enables further enrichment of acute-stage medical care.
