Abstract
Objectives: The introduction of a lump-sum payments based on a diagnosis-procedure combination (DPC) has had a great impact on intensive care in Japan. In this study we examined the correlation between DPC-based payments and the severity of illness of critically ill patients. Methods: The profit-loss indicator (ΔP%) was calculated from the amount of DPC-based payment and the amount that would have been paid by totaling the cost of each individual item by the piece rates. The correlation between acute physiology and chronic health evaluation II (APACHE II, A-II) scores and ΔP% values was analyzed, and the association between A-II scores and ΔP% values in cases in which the patient had died or in which blood purification had been performed was investigated. Results: No statistically significant correlation was found between the A-II scores and ΔP% values. There was a positive correlation between the A-II scores and ΔP% values in 18 cases in which the patient died, while the ΔP% value was greater than +20% and less than − 20% in 1 patient and 6 patients, respectively. There was a negative correlation between the A-II scores and ΔP% values in the 23 cases in which blood purification had been performed. 7 of the 23 patients whose A-II score was above 19 died. Conclusions: Novel DPC related to severity of illness of critically ill patients should be developed in intensive care.
