Economic impact of the first wave of the COVID-19 pandemic on acute care hospitals in Japan

  1. Jung-ho Shin
  2. Daisuke Takada
  3. Tetsuji Morishita
  4. Hueiru Lin
  5. Seiko Bun
  6. Emi Teraoka
  7. Takuya Okuno
  8. Hisashi Itoshima
  9. Hiroyuki Nagano
  10. Kenji Kishimoto
  11. Hiromi Segawa
  12. Yuka Asami
  13. Takuya Higuchi
  14. Kenta Minato
  15. Susumu Kunisawa
  16. Yuichi Imanaka

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Abstract

In response to the coronavirus diseases 2019 (COVID-19) pandemic, the Japanese government declared a state of emergency on April 7, 2020. Six days earlier, the Japan Surgical Society had recommended postponing elective surgical procedures. Along with the growing public fear of COVID-19, hospital visits in Japan decreased.

Methods

Using claims data from the Quality Indicator/Improvement Project (QIP) database, this study aimed to clarify the impact of the first wave of the pandemic, considered to be from March to May 2020, on case volume and claimed hospital charges in acute care hospitals during this period. To make year-over-year comparisons, we considered cases from July 2018 to June 2020.

Results

A total of 2,739,878 inpatient and 53,479,658 outpatient cases from 195 hospitals were included. In the year-over-year comparisons, total claimed hospital charges decreased in April, May, June 2020 by 7%, 14%, and 5%, respectively, compared to the same months in 2019. Our results also showed that per-case hospital charges increased during this period, possibly to compensate for the reduced case volumes. Regression results indicated that the hospital charges in April and May 2020 decreased by 6.3% for hospitals without COVID-19 patients. For hospitals with COVID-19 patients, there was an additional decrease in proportion with the length of hospital stay of COVID-19 patients including suspected cases. The mean additional decrease per COVID-19 patient was estimated to 5.5 million JPY.

Conclusion

It is suggested that the hospitals treating COVID-19 patients were negatively incentivized.

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  1. Version published to 10.1371/journal.pone.0244852
  2. Version published to 10.1101/2020.11.09.20228791v2 on medRxiv
  3. ScreenIT

    SciScore for 10.1101/2020.11.09.20228791: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: The Ethics Committee, Graduate School of Medicine, Kyoto University approved the study (approval number: R0135).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variableFor inpatient and outpatient cases, we presented the number of males and the mean, median, and 1Q and 3Q for the ages and the claimed hospital charges.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    All statistical analyses were performed using SAS software version 9.4 (SAS Institute Inc.
    SAS
    suggested: (SASqPCR, RRID:SCR_003056)
    SAS Institute
    suggested: (Statistical Analysis System, RRID:SCR_008567)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Payments for emergency rooms and intensive care units were doubled, and the limitation on the number of days for which the fees could be claimed was extended from 14 days to 21 or 35 days, depending on the status of the patient [11]. These payments were tripled on May 26 [20]. In our data, there were only 11 such claims for these doubled payments in six hospitals (data not shown). This indicates that the increase in payments for severe COVID-19 patients did not compensate for the decrease in income of hospitals with COVID-19 patients. Our regression analyses showed that the LOS of COVID-19 patients, including suspected patients, was associated with an additional decrease in claimed hospital charges. Other hospital-level variables were not selected in the stepwise process. One of the reasons for this might be that the mean of claimed charges during the previous 21-month period was such a strong predictor that other hospital-level variables were not particularly effective for predicting claimed charges in April and May 2020. Our results suggested that the decrease in claimed charges was in proportion with the LOS of COVID-19 patients regardless of their severity. This implies hospitals treated COVID-19 patients were negatively incentivized. The current raise for payments was focused on severe COVID-19 patients, although the proportion of severe cases was not very high in Japan. Moreover, our results showed that the elective cases decreased more in April and May 2020 and returne...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a protocol registration statement.

    About SciScore

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  4. Version published to 10.1101/2020.11.09.20228791v1 on medRxiv