KOBAYASHI Yasuki Teikyo University, Medicine, Assistant Prof., 医学部, 講師 (70178341)
YANO Eiji Teikyo University, Medicine, Associate Prof., 医学部, 助教授 (50114690)
|Budget Amount *help
¥2,200,000 (Direct Cost : ¥2,200,000)
Fiscal Year 1991 : ¥900,000 (Direct Cost : ¥900,000)
Fiscal Year 1990 : ¥1,300,000 (Direct Cost : ¥1,300,000)
The current Japanese postgraduate medical education(PGME)system was established in 1968 under the revised Medical practitioners Law. Several problems exist in the current PGME system. There are no mminimum standards required, and no system for evaluation of the teaching programs has been established yet. PGME has a tremendous influence on the national supply of medical care by improving the clinical skills of individual residents. We surveyed all the teaching hospitals in Japan to evaluate factors related to LOS and cost.
In order to identify the factors responsible for the longer LOS, the analysis was carried out. In this study, we focused on conditions of residency training as well as general characteristics of teaching hospitals in Japan for their effect on LOS. Based on multivariate analysis the most important factors related to conditions of residency training included number of inpatients, operation rate per admission, autopsy rate per bed, and nineteen other factors of lessor imp
ortance. Similarly, factors related to general characteristics of teaching hospitals, were whether or not the resident was responsible for the work-up plan, whether or not the resident had experienced in an outpatient clinic, and the size of the stipend for residents, etc. were used. The result of multivariate analysis of the data suggested that LOS was related to the conditions of residency training independently of general characteristics of the hospitals.
To evaluate high-medical cost, the survey results for the patients attended by residents were analyzed. In this study, procedures worth more than 1000 points in the national insurance scheme were included. Medical costs per patient were analyzed by using gender, age, diagnosis, proportion of cost paid for insurance, type of insurance, type of hospital, prognosis, and the proportion of the total cost going to high cost procedures, as independent variables. As a result, x-rays, injections, physical therapy treatments, and laboratory examinations were found to have to have cost procedures in the order given. Less