Comment on “How does the Price Regulation Policy Impact on Patient–Nurse Ratios and the Length of Hospital Stays in Japanese Hospitals?”

• DOI: http://doi.org/10.1111/aepr.12110
• Published date: 01 July 2015
• Date: 01 July 2015
• Author: Ayako Kondo

Comment on “How does the Price

Regulation Policy Impact on Patient–Nurse

Ratios and the Length of Hospital Stays in

Japanese Hospitals?”

Ayako KONDO†

Yokohama National University

JEL codes: I11, I18

It has been said that the fee-for-service (FFS) system in Japan’s public health insurance

system is a major contributor to Japan’s relatively low national medical expenditures.

Basically, this system allows the central government to almost fully control the prices of

medical services through the reimbursement system of public health insurance, which

covers most of the medical usage in Japan. This price control has been used for not

only suppressing total medical expenditures, but also for balancing the allocations of

medical resources by making higher rewards for services in short supply. Noguchi

(2015), however, reveals the limitations of this approach by showing the “overreaction”

of patient–nurse ratio (PNR) to changes in the FFS criteria.

I have four major comments on Noguchi’s (2015) paper. First, I would have liked to

have seen a more detailed description about the reasons why the government wanted to

lower PNR at the particular times it did. In particular, since the abstract and conclusion

read as if the main policy implication of Noguchi (2015) is that the changes in the FFS

caused an undesired outcome (an increase in beds for acute care), Noguchi should

explain why the government, which wanted to reallocate health-care resources toward

subacute and long-term care, also aimed to lower the PNR at the same time. As men-

tioned in Noguchi’s paper, the changes in FFS intended to lower PNR and shorten the

length of hospital stays (LHS), and the empirical results suggest that both PNR and LHS

actually decreased in response to the changes. That is, the revision achieved its primary

objectives. If the final goal of this fee revision is to expedite the treatment of acute dis-

eases through the provision of more intensive human resources, I feel it is off the point

to accuse hospitals of inducing more resources toward acute care.

A second and related comment relates to the overall goals of the series of FFS revi-

sions in Japan. In the concluding section, Noguchi argues that “[a] series of revisions of

FSS aim to clarify and differentiate the roles and functions of medical facilities with

various characteristics” (p. 318), and this argument seems to be the basis for the rather

negative tone of Noguchi’s overall evaluation of the FFS revision in 2000 and 2006.

†Correspondence: Ayako Kondo, Faculty of International Social Sciences, Yokohama National

University, 79-4 Tokiwadai, Hodogaya, Yokohama, Kanagawa 240-8501, Japan. Email: akondo@

ynu.ac.jp

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doi: 10.1111/aepr.12110 Asian Economic Policy Review (2015) 10, 324–325

© 2015 Japan Center for Economic Research324