Abstract
In Japan, the departments of psychiatry in general hospitals have been facing financial difficulties under the present medical fee system. Many general hospitals reduced or removed the number of psychiatric beds, and, furthermore, some hospitals discontinued psychiatric services. Of these, the outpatient clinic for dementia in general hospitals has been put in the most difficult situation in terms of profitability. Its roles in general hospitals include the early detection and differential diagnosis of dementia using diagnostic devices, as well as the diagnosis and treatment of physical complications, often in cooperation with other medical departments. These processes involve a large number of examinations, such as hematological, neuropsychological, and diagnostic imaging, compared to those conducted in general psychiatric outpatient clinics; however, the profit associated with these examinations does not meet the requirements for maintaining the outpatient clinic for dementia in general hospitals. I examined and confirmed the profitability of our outpatient clinic for dementia using actual data, and pointed out several problems of conventional referral systems.
