Inequity in the price of physician activity across surgical procedures.

OBJECTIVES A rational payment system is being sought in Japanese health care-one that accurately reflects the required time and the level of technical difficulty when valuing physician activity. The objective of this study is to examine the current surgical payment system in Japan by clarifying the hourly values allocated to physician activity. METHODS This study focused on the 22 surgical procedures most frequently registered in our study database of administrative data gathered from 11 teaching hospitals in Japan. The current fee-for-service reimbursement system does not formally define which cost components surgical fees cover. It was therefore necessary for us to examine directly each reimbursement item to determine which component it represented. Next we examined the current system from the following viewpoints: (1) variation in the hourly values allocated to physician activity, for an individual surgeon or a surgical team, among types of surgery by using the actual data; (2) the association between the hourly values and the operation time or the level of technical difficulty. RESULTS The hourly values allocated to physician activity were low (US dollars 61.0 and 121.5 per surgeon: means of case 1 and case 2 estimations). The hourly values varied inequitably among types of surgery (from US dollars -28 to 237 and from US dollars 6 to 328: ranges in the case 1 and case 2 estimations). When long surgeries were excluded, shorter surgeries tended to have higher hourly values. The association between the hourly values and the difficulty level was less clear and their variation was large even at the same difficulty level. CONCLUSION In the current payment system, the surgical fee is deemed to include fee for physician activity as well as materials, equipment and so on. To develop a rational payment system, first, the scope of the surgical fee and that of the physician activity fee should be separated and clearly defined. Second, the latter should be modeled to reflect the manpower volume and the level of technical difficulty needed for each surgical procedure. Third, fees should be set by utilizing the cost estimates with empirical data.