Key result
Larger healthcare facility size linked to ~$89 higher outpatient orthopedic surgery costs per 100 beds.
Observational (n=6,456)
Yes
Effect estimate: Incremental total cost of $89.2 per 100 beds
p-value: p=<0.05
Outpatient orthopedic surgery costs in Japan are positively associated with healthcare facility size, specifically total bed count.
Larger facilities may incur higher orthopedic costs; hypothesis-generating and should not yet change practice or policy.
Purpose The purpose of this paper is to examine the association between outpatient orthopedic surgery costs and Japan's healthcare facilities using a large-scale Japanese medical claims database. Design/methodology/approach The authors obtained reimbursement claims data for 8,588 patients who underwent orthopedic surgery between April 1 and September 30, 2014 at 3,347 Japanese healthcare facilities. Regression analysis, using ordinary least squares, examined the association between outpatient orthopedic surgery costs and healthcare facility characteristics. By using surgical fees as proxy for the surgical costs, the authors defined three dependent variables: surgical cost for each outpatient orthopedic surgery; pre- and post-operative cost one month before and after a surgical operation; and total cost for each patient. The authors also defined five independent variables, which capture healthcare facility characteristics and patient-specific factors: bed count; whether healthcare facilities are reimbursed in a diagnosis procedure combination system; patient's age; sex; and anatomical surgical sites. Findings The authors analyzed 6,456 outpatient orthopedic surgical cases performed at 3,085 healthcare facilities. There were significant differences in the surgical costs for outpatient orthopedic surgery among different healthcare facilities by total beds ( p=0.000). Multivariate regression analysis shows that surgical costs for outpatient orthopedic surgery are positively and significantly associated with healthcare facilities classified by total beds after adjusting for patient-specific characteristics ( p<0.05). Originality/value This is the first research to examine the association between costs for outpatient orthopedic surgery and healthcare facility characteristics in Japan. This study via the multivariate regression method showed that outpatient orthopedic surgery is likely to cost higher as healthcare facility size increased. The average incremental costs for each outpatient orthopedic surgery per 100 beds were calculated at $48.5 for surgery, $40.7 for pre- and post-operative care, and $89.2 total cost.
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Watanabe et al. (2018) conducted an observational in Outpatient orthopedic surgery (n=6,456). Healthcare facility size (bed count) vs. Smaller healthcare facilities was evaluated on Surgical costs for outpatient orthopedic surgery (surgical, pre/post-operative, and total costs) (Incremental total cost of $89.2 per 100 beds, p=<0.05). Outpatient orthopedic surgery costs were positively associated with healthcare facility size, with an average incremental total cost of $89.2 per 100 beds (p<0.05).
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