2013 Volume 3 Issue 1 Pages 11-20
Aim: The purpose of this study was to clarify the relationship of Nursing Need Degree (NND) and hospital charges under the Diagnosis Procedure Combination/Per-Diem Payment System (DPC/PDPS).
Methods: A longitudinal cohort study design was used to examine all 28,757 hospitalizations in Hospital A between July 2008 and March 2010. Per-nurse day unit prices were calculated for each DPC group if the number of patients included in the particular DPC group exceeded 20. We then classified all 179 DPC groups into 3 clusters based on per-nurse day unit price: underestimated, average, and overestimated. The ratio of appearance of each NND item, as well as scores for Items A and B of NND, were then compared.
Results: The ratio of appearance for “use of anticancer drugs” in the overestimated cluster of Item A was substantially higher than in the other clusters. Ratios of appearance for all items in the underestimated cluster of Item B were higher than in the other clusters. Mean scores for Items A and B in the underestimated cluster were higher than in the other clusters.
Conclusions: The present findings contribute to the identification of DPC codes that do not adequately reflect nursing services required under the present DPC payment system, and also suggest the possibility of improvement by incorporating nursing needed in the DPC system.