• Jung-Ho Shin, Daisuke Takada, Tetsuji Morishita, Hueiru Lin, Seiko Bun, Emi Teraoka, Takuya Okuno, Hisashi Itoshima, Hiroyuki Nagano, Kenji Kishimoto, Hiromi Segawa, Yuka Asami, Takuya Higuchi, Kenta Minato, Susumu Kunisawa, and Yuichi Imanaka.
• Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
• Plos One. 2020 Jan 1; 15 (12): e0244852.

BackgroundIn 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.MethodsUsing 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.ResultsA 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.ConclusionIt is suggested that the hospitals treating COVID-19 patients were negatively incentivized.

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