This paper quantitatively analyzed whether there were differences in cost structures between the surplus hospital group (N=57) and the deficit hospital group (N=44), using financial statement data of the National Hospital Organization. The results showed that there were differences between the 2 groups in the following items:(1) insurance assessment;(2) salary expense;(3) material costs;(4) medical material costs;(5) equipment-related costs;(6) depreciation expense;(7) other expenses;and (8) interest paid.
The present study suggested the following points:first, the importance of cost effectiveness in hospital management was verified using a quantitative analysis method;second, expense items that may define the boundary line between surplus and deficit hospitals were concretely specified;and third, the possibility that cost focus strategy is effective in hospital management was suggested by data analysis.

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The purpose of this study is to clarify the pros and cons of cash benefits for family care and the underlying reasons in families who care for home help service station users at home and to investigate how nursing care services and cash benefits could be allocated for family care. A questionnaire survey was conducted among 850 caregivers, of whom 350 responded. Thirty-three point three percent opposed cash benefits, 37.4% supported them, and 29.3% were undecided. The reasons for supporting cash benefits were the presence of services that cannot be used for economic reasons and a high cost burden, whereas the opposing reasons were problem behaviors and the absence of services in local areas.
There are pros and cons of cash benefits, and a national debate is necessary in the future. As a desirable state of the long-term care insurance, cost reduction for low-income households and improvement of services in local areas with insufficient services should be sought, and after that cash benefits should be considered based the case-by-case evaluation of family care. In order to provide cash benefits in an appropriate manner, environmental improvements are required, such as establishing a system to ensure the quality of family care and, in particular, monitoring by a third party.

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The purpose of this study was to clarify the influence of night-shift work on nurses by analyzing changes in activity, sleepiness, fatigue and physiological indices in nurses during night shifts.
Sublingual temperature, fatigue (visual analog scale:VAS) and sleepiness (VAS) were measured hourly in 7 night-shift nurses (hereafter referred to as the “clinical” group) and 15 university students (hereafter referred to as the “control” group) and, furthermore, an electrocardiogram and activity meter were attached to the nurses.
The results demonstrated positive correlations between fatigue and sleepiness and between fatigue and time in both groups, revealing that fatigue increases with time and that sleepiness changes in a similar way as fatigue. However, although the “clinical” group showed a significant increase in body temperature, decrease in sleepiness and decrease in fatigue at 6 AM compared with the “control” group due to an increase in activity, changes in frequency components indicated an increase in fatigue after 6 AM in the “clinical” group. It was suggested that an increase in activity and tension in the morning suppressed sleepiness to mask fatigue.

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Medical costs following incidents and accidents within hospitals are not linked with primary diseases, and these costs may be borne by hospitals where patients are injured. It is therefore very important for policy makers and hospital managers to recognize the actual situation of additional medical costs for incidents. Cases with over level two injuries and their associated medical costs were explored over three years.
We collected 7,717 incident reports between 2007 and 2009 at Saint Mary's Hospital in Kurume-City, Fukuoka, Japan. Their reports included 1,790 cases for Falls/Slips. There were 824 cases for Falls/Slips classified as level 2,298 cases for level 3a, and 46 cases with level 3b.
At the injury level, average additional medical costs were 10,070±7,934 JY* (level 2, 205 cases), 12,859±15,772 JY (level 3a, 186 cases), and 226,723±281,065JY (level 3b, 34 cases), and there were statistically significant differences among them (2 and 3a:p=0.027, 3a and 3b:p<0.001). Average medical costs were directly calculated from the insurance medical fee schedule under the social insurance system.
As a result, the total amount of additional medical costs for Falls/Slips is estimated to be seven million JY at our hospital, as additional medical costs are 2.8 million JY with level 2, 1.3 million JY with level 3a, and 3.5 million JY with level 3b. Therefore, it is suggested that patient safety activities need to be conducted in order to prevent patients with level 3b injuries from Falls/Slips.
*JY=Japanese Yen

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The practice of obstetrics and gynecology (Ob/Gyn) raised a social issue. We developed a new methodology which combines work hour log and administrative data, and further assessed Japanese Ob/Gyn practice workload.
Thirty-four Ob/Gyn physicians from 4 hospitals were recruited to self-report work hour log for 1 week. And then medical procedures were extracted from administrative (Diagnosis Procedure Combination DPC) data and aggregated. Finally we integrated data derived from the above two methods to assess factors underlying increased work hours in Ob/Gyn practice.
Results shows work duration for a single physician averaged 558 minutes per day in total, with 112 minutes for outpatient care, 306 minutes for inpatient care, 87 minutes operating, and 42 minutes for other services. Our data also demonstrates that the number of operations, vaginal deliveries, and intensive care patients influenced work hours for inpatient care. Using these factors, we could estimate requisite workloads for Ob/Gyn practice. Improved estimation of workload permits more concrete discussion on how to restructure the healthcare system.

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