Abstract
In Japan, functional differentiation of hospitals is in progress to promote the policy where hospitals should be specialized in inpatient medical care while clinics provide outpatient medical care. However, even to this date, a great number of patients with mild diseases visit large hospitals. We have identified the status of outpatient visits of patients with mild diseases to large hospitals.
Hospitals with 200 general ward beds, belonging to the National Hospital Organization, were defined as large hospitals. The data used in the analysis were derived from the Health Insurance Claim Form for Outpatient Services, collected from 84 hospitals. A total of 106496 patients who made an outpatient visit to one of the participating institutions on September 30, October 2 or October 4, 2013, were analyzed. Patients were rated as either mild or non-mild. The analysis was performed for medical care contents and health care costs for each visit. “Patients with mild diseases” were defined as “patients whose health insurance claims were limited to injection/medication/dispensing fees, rehabilitation and specialized psychotherapy, excluding patients receiving anticancer drugs.” Then, patients who made outpatient visits during the period from April 1, 2013, to March 31, 2014, were analyzed for visiting status per year for each patient（N=2,119,357）.
The analysis per visit revealed that there were 39458 patients （37.1%） with mild diseases and 67038 patients （62.9%） with non-mild diseases. By hospital size measured by the number of beds, the proportion of patients with mild diseases was 42.0% in hospitals with 200 to <300 beds, whereas it was 34.7% （p < 0.05） in hospital with 400 to <500 beds and 34.5% （p < 0.05） in hospitals with 500 to <600 beds, showing a significant difference. The total health care costs for patients with mild diseases were about 220 million yen, accounting for 13.4% of the total health care costs for all patients. The analysis per patient revealed that the average number of visits by a patient was 4.11 （SD = 5.53）, and that patients making 12 visits or less per year accounted for 94.7%. In addition, there were 337,281 patients （15.9%） who made all visits with mild diseases.
The analysis per visit revealed that about 40% of patients had mild disease, and that patients whose treatment did not affect the hospital’s income in outpatient care were treated in large hospitals. The analysis per patient revealed that about 16% of patients made all the visits with mild diseases. These results suggest that strengthening cooperation between hospitals and medical clinics can reduce the number of patients without causing significant impact on the revenue of the hospital, allowing the redundant human resources to be used for inpatient medical care.
