日本医療経営学会誌
Online ISSN : 2187-8951
Print ISSN : 1883-7905
ISSN-L : 1883-7905
7 巻 , 1 号
選択された号の論文の13件中1~13を表示しています
巻頭言
原著
  • 福井 早苗
    2013 年 7 巻 1 号 p. 5-13
    発行日: 2013/08/31
    公開日: 2013/09/13
    ジャーナル フリー
    Supply chain management in Japanese healthcare industry struggles to reform its distribution systems due to the necessity of cutting costs, because the expenditure of medical materials is thought to account for nearly one quarter of all expenditure in a hospital. The finding of the research is three issues to which the Japanese industry should overcome. There are 1) the use of IT: from the perspective of shorten lead time, 2) the enhanced purchasing power: cooperation with neighbouring hospitals, 3) the need for warehouse in remote area and in emergency including diverse disasters.
  • 林 行成, 丁井 雅美, 小西 幹彦, 増原 宏明
    2013 年 7 巻 1 号 p. 15-22
    発行日: 2013/08/31
    公開日: 2013/09/13
    ジャーナル フリー
    Recently, in Japan, the performance-related compensation system is in widespread use in health care management. Individuals who devote professional attention to health care services have relatively strong intrinsic motivation. Therefore, an introduction of performance-related compensation system to medical organization likely discourages them. In this paper, we analyze a nature of performance-related compensation system from a viewpoint of health care management. In particular, we consider individuals’ preference types as follows: selfish preference treated in standard economics, equity-oriented preference, input-oriented preference, and output-oriented preference.Then, we show a possibility such that an introduction of performance-related compensation system decreases efficiency. And then, we investigate a way of performance-related compensation system in health care management.
  • 増原 宏明, 小西 幹彦, 丁井 雅美, 林 行成
    2013 年 7 巻 1 号 p. 23-29
    発行日: 2013/08/31
    公開日: 2013/09/13
    ジャーナル フリー
    The profit loss statement of hospitals contains two properties of profit and policy because hospitals have the characteristics of public goods. Therefore, we need to distinguish and allocate costs between health care policy and profit using segment accounting. However, cost allocation is a difficult problem and always becomes arbitrary in health care management. This paper considers cost allocation in health care management based on statistical view, specifically using finite mixture models. Since cost allocation using conventional finite mixture models is interpreted as either profit or health care policy, this paper proposes a new finite mixture model with the state of both profit and health care policy. Monte Carlo experiments show that the parameter estimates of a new finite mixture model is are unbiased but the convergence speed is quite slow.
  • 遠矢 雅史, 梅里 良正, 前田 幸宏, 寺崎 仁, 大道 久
    2013 年 7 巻 1 号 p. 31-41
    発行日: 2013/08/31
    公開日: 2013/09/13
    ジャーナル フリー
    The purpose of this research is to reveal the costs, mainly the labor costs on medical safety management, and to validate the invested costs and the effects for ensuring medical safety. The self-completed questionnaire method was conducted in the 1514 hospitals. In addition, we undertook the relationship analysis on the effects for ensuring medical safety by defining medical safe score and medical risk score based on the results of hospital accreditation. The result was 22,314yen on average (median 17,391 yen), that was converted to 1 bed per month. The result of the relationship analysis between the medical safe score and medical risk score, and the labor costs invested on medical safety, calculated based on the Spearman rank-correlation coefficient was statistically-significant. This research shows the more hospitals invest human resources on medical safety management, the higher the medical safety in those hospitals would be.
  • 小林 孝弘, 高橋 泰
    2013 年 7 巻 1 号 p. 43-53
    発行日: 2013/08/31
    公開日: 2013/09/13
    ジャーナル フリー
    Duties of nursing staffs are regulated by rules from various laws or ordinances. If the ward could not follow the rules, hospital administration would receive serious penalty such as reduction of medical payment or suspension of business. This paper will propose a method to calculate just enough and lowest cost supplement of nursing staffs using LP (Linear Programming). This application of LP is not explicitly proposed, although LP is one of the most popular methods to calculate the best distribution of resources. If there is no contradiction in LP problem, LP can solve the problem by all means. And a support tool we developed can reduce time and effort for the calculation dramatically. This study would offer certain reason for nursing staff supplement not to exceed necessity, so that medical resources distribution would be much more reasonable and effective.
  • 山口 久美子, 池田 俊也, 武藤 正樹, 成田 徹郎
    2013 年 7 巻 1 号 p. 55-65
    発行日: 2013/08/31
    公開日: 2013/09/13
    ジャーナル フリー
    We surveyed the state of nurse working environment and job satisfaction and used data mining to clarify the factors that influence nurses to leave the nursing profession; this was done to find ways to prevent nurses from leaving their jobs. With the perspective of bed management added as a working environment factor, the questionnaire was administered during March 2011 to 4,803nurses from 25 social insurance hospitals throughout Japan, who consented to cooperate.Responses were obtained from 4,087 nurses and the 2,112 nurses with no missing values for responses were included in subject analysis. Data mining was based on a characteristic discriminant model of decisions to leave the nursing profession. Nurses “not wanting to quit their job” were influenced by working environment and manager expectation and approval. Nurses “considering quitting their job” were influenced by interpersonal relationships with superiors, degree of autonomy in decision-making, and educational support. Bed management also influenced “considering quitting their job.” We found that the role of the head nurse is important in preventing nurses from quitting their jobs and that management, including bed control, is needed.
総説
  • 上原 勉, 真野 俊樹
    2013 年 7 巻 1 号 p. 67-74
    発行日: 2013/08/31
    公開日: 2013/09/13
    ジャーナル フリー
    There are still a number of challenges remain in promoting the use of generic drugs in Japan, although the market share of the drugs has been increasing due to the policy inducements, including the revision of the medical fees and the drug pricing system, adopted by the Japanese Government, who set a target on increasing the usage of generic drugs as a government policy. Therefore, in this article, it was examined that what effective policies would be on promoting the usage of generic drugs, in light of the challenges emerging from the transition of the concerning policies, and the surveys on the actual usage of generic drugs. In conclusion, the improved credibility of generic drugs, and the establishment of the drug pricing system that is able to induce economic incentives for patients, would be considered as effective policies on promoting the usage of generic drugs.
調査報告
  • 石川 雅俊, 高橋 泰
    2013 年 7 巻 1 号 p. 75-82
    発行日: 2013/08/31
    公開日: 2013/09/13
    ジャーナル フリー
    In this study, we built to assemble “secondly medical regions database” and analyzed the feature of each medical region using principal component analysis. As a result of the study, we extracted three principal components. The first component was how urbanized the region was. The second one was how plenty acute care was offered. And the third one was how plenty sub-acute and chronic care was offered. Additionally, by using the result of the principal component scores, we displayed the huge gap of Japanese medical delivery system among medical districts. In considering the directionality of the allocation of medical resources in each medical region, it would be desirable in assigning standard hospital bed capacities to consider assignments of beds by reflecting the degrees of urbanization of the regions and the future demands.
  • 簑 貴子
    2013 年 7 巻 1 号 p. 83-91
    発行日: 2013/08/31
    公開日: 2013/09/13
    ジャーナル フリー
    The purpose of the present study is to investigate the educative effect of intervention using management training material in 508 staff nurses who work for 3 facilities. After educational intervention was provided to the nurses for 2 months using original management training material, an anonymous self-administered questionnaire of 53 items was carried out to survey hospital management awareness. 381 nurses responded the survey. Improvement of 14 items was significant at the 5% level in χ2 test. Awareness of the relationship between in-hospital infection control and cost saving showed the most significant improvement in 21.1% of nurses at the 1% level after educational intervention. Mann-Whitney U test revealed that, although nurses having a career in other hospitals were poorly aware of the relationship before educational intervention compared with those without a career, significant difference disappeared after intervention. The findings suggest that the awareness items improved by educational intervention were related to the daily nursing service and the reimbursement system.
  • 関口 潔, 赤瀬 朋秀
    2013 年 7 巻 1 号 p. 93-98
    発行日: 2013/08/31
    公開日: 2013/09/13
    ジャーナル フリー
    To investigate the influences of the 2010 revision of medical reimbursement system on the sales figures of the 39 pharmaceutical companies listed on the Japanese stock exchange market, the financial data obtained from EDINET (Electronic Disclosure for Investors’ NETwork) were examined. In April 2010, 5.75% of the standard price of drug prescribed under the Japanese Health Insurance System was reduced, which caused 2.62% reduce of drug costs in the national medical expenditure from 8.01 trillion yen to 7.80 trillion yen. However, there was no decrease in the gross sales of 39 pharmaceutical companies listed in Japanese stock market, and furthermore the sales of four high ranks increased considerably all. The rate of change of drug costs in the national medical expenditure in drug price revision year (1998–2011) was −2.38±4.747 (mean±s.d.)%, which was statistically lower than 5.57±2.741 (mean±s.d.) % of that in non-revision year (P<0.05: Wilcoxon signed-ranks test).
  • 姜 珠賢, 松浦 清
    2013 年 7 巻 1 号 p. 99-105
    発行日: 2013/08/31
    公開日: 2013/09/13
    ジャーナル フリー
    The objective of this paper is to evaluate Japanese and Korean systems of accreditation of healthcare organizations from meta-evaluation aspects, then to provide improvement points of them for the future sake. The frame work of this consists of four factors which are evaluation environment, evaluation processes, evaluation results and utilization of evaluation results. The findings are as follows: 1) there are different positions in terms of evaluation and accreditation objectives between organizations of accreditation and healthcare institutions; 2) there is a pointed out fact in evaluation processes that the stress intensity of staff who is in charge of preparing for certifications is high;3) there are low utilizations of information based on the results of evaluation by patients who get benefits of medical services; 4) there are common factors that even if both countries obtained certification, there would have no direct relation to the increase of revenue of medical institutions.
  • 松村 耕平
    2013 年 7 巻 1 号 p. 107-119
    発行日: 2013/08/31
    公開日: 2013/09/13
    ジャーナル フリー
    This study is to analyze the supply-demand balance of the obstetrics care of each secondary medical region and to suggest an improvement method. For proceeding the analysis, we initially have developed secondary medical region database for obstetrics and perinatal period. As a result, we can calculate the number of obstetricians per 100,000 women from 15–49 years old, and we can select the secondary medical region facing difficulty in case of delivery. At the same time, we can calculate the regional difference of obstetricians’ load. In the future, it will be necessary to grasp the detailed data of the secondary medical region to improve this area uneven distribution and medical supply-demand balance.
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