The suppressive effect on the number of patients with the introduction of off-hours medical expenses in Japan

MITSUNAGA T, OHTAKI Y, KIRIYAMA N, OHTANI K, YAJIMA W, HIBI T, TAKEDA S. The suppressive effect on the number of patients with the introduction of off-hours medical expenses in Japan. Med Emergency, MJEM 2019; 27:11-6.
doi: 10.26738/MJEM.2017/MJEM27.2019/TM.OAE.080518

Key words: emergency department, Japan, off-hours medical fees, overcrowding, university hospital

  • Authors’ affiliation
  • Article history / info
  • Conflict of interest statement

Correspondent author: Toshiya Mitsunaga, MD

Department of Emergency Medicine, Tokyo Jikei University School of Medicine,

3-25-8 Nishishinbashi, Minato-ku, Tokyo 105-8461, Japan

toshi_promise_kt@yahoo.co.jp; toshiya.m@jikei.ac.jp

Mitsunaga T, MD, Ohtaki Y, MD, Kiriyama N, MD, Ohtani K, MD, Yajima W, MD, Hibi T, MD, Takeda S, MD

Department of Emergency Medicine, Tokyo Jikei University School of Medicine, Tokyo, Japan

Category: Original article

Received: Mar. 06, 2018

Revised: Apr. 03, 2018

Accepted: May 08, 2018

There is no conflict of interest to declare

ABSTRACT

Aim: In Japan, people can visit all hospitals, including university hospitals, at no cost, and this free access system has several benefits for patients. However, over the last two decades, overcrowding in Emergency Departments (ED) has become a serious problem in Japan, making it difficult to manage severe patients intensively. Some university hospitals have introduced off-hours medical fees. The purpose of this study is to analyze the influence on patient’s behavior after the introduction of off-hours medical fees and to examine the proper use of the ED.

Methods: From April 2014, we introduced off-hours medical fees (72 euros: 1 euro = 120 yen). We followed 41,337 patients who came to our ED from April 2013 to March 2015, andwe divided them into two groups; Group A (before off-hours medical fees were introduced), which was from April 2013 to March 2014, Group B (after introducing off-hours medical fees), which was from April 2014 to March 2015.

Results: The overall number of walk-in patients significantly decreased, from 42.15 ± 1.64/day to 31.09 ± 1.00/day. The overall number of ambulances accommodated slightly decreased from 20.09 ± 0.50/day to 19.93 ± 0.54/day, and the overall number of patients who were hospitalized in our hospital also slightly decreased from 9.08 ± 0.30/day to 8.39 ± 0.30/day, but there were no significant differences.

Conclusion: After off-hours medical fees were introduced, the number of non-emergency patients decreased to about 70%, but the rates of hospitalization and ambulance reception hardly changed. The results of our study suggest that introducing off-hours medical fees can reduce the number of non-emergency patients selectively.