Keywords
Japan
off-hours medical fees
overcrowding
university hospital
How to Cite
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 per day (/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.
References
Ministry of Internal Affairs and Communications Fire and Disaster Management Agency: Current status of emergency and rescue in 2012.
Ehara A. Annual change of the utilization rates of pre-hospital medical services for newborns, infants, children, adults and the elderly in Japan. J Jpn Med Assoc 2010; 139:1689-92. https://apps.who.int/iris/bitstream/hand le/10665/259941/9789290226260-eng.pdf (Last access 17/02/2018)
Ehara A. Extra-charge collection in visiting at night and in holidays in japanese medical facilities. J Jpn Med Assoc 2009; 138:1160-2.
Ehara A. Effect of the extra-payment on the ER visiting at night and in holidays. J Jpn Soc Emerg Med 2009; 12:516-9.
Yoshida Y. Impact on pediatric emergency medical care through introduction of off-hours medical expenses. J Jpn Soc Emerg Ped 2009; 8:254.
Ito M, Kagawa J, Iketani K. Influence of extra off-hours self-payment system on off-hours visits of children. J Jpn Soc Emerg Ped 2009; 8: 254.
Takagi T, Jitsugane K. The effect of overtime fee for the purpose of alleviating emergency medical service in our hospital. J Jpn Assoc Acute Med 2009; 20:545.
Shirai M, Nasu Y, Kinae Y. The changes in the number of pediatric patients after introduction of specific initial visit fee. J Jpn Pediatric Soc 2009; 113:1461-2.
Kato M, Hukuda O, Kamiyama Y. The changes in the number of patients visiting in off-hours after introduction of overtime fee. J Jpn Soc Emerg Med 2010; 13:176.
Takagi T. Effect of overtime fee in emergency patient. J Jpn Orthop Assoc 2010; 84:S531.
Shirai M, Ishigaki H, Hakamada A. The changes in the number of pediatric patients in off-hours after introduction of specific initial visiting fee andovertime fee. J Jpn Pediatric Soc 2010; 114:196.
Yoshida T, Nakatsu T, Watanabe T. Influence of introduction of selected medical expenses in overtime medical examination to pediatric emergency medical care. J Jpn Pediatric Soc 2010; 114:91-4.
O’Grady KF, Manning WG, Newhouse JP, Brook RH. The impact of cost sharing on emergency department use. N Engl J Med 1985; 313:484-90.
Selby JV, Fireman BH, Swain BE. Effect of a copayment on use of the emergency department in a health maintenance organization. N Engl J Med 1996; 334:635-41.
Hsu J, Price M, Brand R, Ray GT, Fireman B, Newhouse JP, et al. Cost- sharing for emergency care and unfavorable clinical events: findings from the safety and financial ramifications of ED copayments study. Health Serv Res 2006; 41:1801-20.
Wharam JF, Landon BE, Galbraith AA. Emergency department use and subsequent hospitalizations among members of a high-deductible health plan. JAMA 2007; 297:1093-102.
Japan Hospital Association: Emergency medical questionnaire survey result in 2013.
Kamekura S, Kanai H, Kobayashi A, Tanaka Y, Kanazawa A, Masuyama N, et al. Survey of the cases in which the needs of orthopaedic surgeries could not be accepted at our hospital. J Jpn Soc Emerg Med 2014; 17:789-93.
Emergency Promotion Foundation Survey Research Grant Project. Prospective Study on the Reality of Emergency Transportation Acceptance Refusal 2009.
Hirota T, Shiokawa C, Norimoto K, Nosaka Y, Watanabe T. Analysis of Practice Time from Arrival at the Emergency Room to Admission. J Jpn Soc Emerg Med 2005; 8:302-7. https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC1946887/pdf/canmedaj01565-0040.pdf (Last access 20/02/2018).