As of fiscal term ending March 2019, medical corporations of a certain scale must meet the newly established generally accepted accounting principles (GAAP). Until now, there were no unified accounting principles, and comparison of hospital accounting information between different establishments was difficult.

The present study surveyed financial documents submitted to municipalities by medical corporations that were required to do so, and aimed to verify effectiveness of the new GAAP for medical corporations and understand challenges.

External audit, supplementary schedule, and medical services corporation transaction records which had to be submitted for the first time this year clarified the financial information of each medical corporation, indicating their usefulness. On the other hand, there were missed submissions and mistakes in documents, pointing to a future operational challenge to tackle the inadequate systems of the medical corporations preparing documents and the municipalities that check these documents.

The objective of the present study was to discuss the process in which appropriate provision of healthcare and efficient hospital management are achieved through cross-sectional organizations, such as committees in a large hospital organization. This ethnographic study at an acute care general hospital showed that not only organizing committees but also accurately understanding the situation of the healthcare field and creating an organizational system that values cooperation with medical practitioners led to a policy aiming toward efficient hospital management while valuing expertise in the healthcare field. As such, cooperation based on common acknowledgement throughout the whole hospital organization, including the healthcare field, is important in achieving efficient hospital management while providing appropriate healthcare.

The severity of a patient’s condition and the extent of a patient’s need for medical/nursing care (hereafter referred to as “nursing needs”) comprising items A, B, and C were indicators for assessing hospitalized patients’ needs for care. The FY 2016 version of the medical service payment system has initiated the use of an assessment method that uses medical treatment data (assessment method II) in addition to the conventional assessment method (assessment method I). The objective of this study was to elucidate the assessment results based on the differences between these assessment methods. For the analysis, we calculated the ratio of patients satisfying the standards for assessment methods I and II using DPC data, and analyzed the consistency for items A and C. Overall, 750 facilities, 6,105 wards, and 26,294,407 cases were analyzed. Assessment method I had a higher ratio of patients satisfying the severity standard for nursing needs compared to assessment method II, with an average difference of “≥800 beds”=2.3, “600–799 beds”=2.9, “400–599 beds”=3.0, “200–399 beds”=4.5, and “<200 beds”=5.8. Consistency between the two assessment methods for item A was lower than that for item C. Although assessment methods I and II have different origins and are not completely consistent, it was evident that the characteristics of the facilities also had an impact on these differences.