Effects of revisions to the health insurance system on the recovery-phase rehabilitation ward

[ABSTRACT] In the present study, we investigated the effects of revisions to the medical fee system made in April 2006 on the recovery-phase rehabilitation ward of our hospital. Subjects were patients admitted to the recovery-phase rehabilitation ward of our hospital between April 1, 2005 and September 30, 2006, and were discharged. Patients admitted between April 1, 2005 and March 31, 2006 were allocated to the pre-revision group and those admitted between April 1, 2006 and September 30, 2006 to the post-revision group. Their medical charts were investigated for comparison of the mean age, duration of hospitalization, and outcome. A total of 126 patients were allocated to the pre-revision group, and 72 to the post-revision group. The number of days from onset to admission to the recovery-phase rehabilitation ward was 41.3 days in the pre-revision group and 26.1 days in the post-revision group, while the duration of hospitalization was 71.4 days in the former group and 41.9 days in the latter. The outcomes were transfer to homecare/discharge to home in 84 patients (67%) and transfer to another department in our hospital in six patients (5%) in the pre-revision group, and 43 patients (60%) and 14 patients (19%) , respectively, in the post-revision group. No significant differences in FIM were found between the two groups. The effects of the medical fee system revisions made in April 2006 on the recovery-phase rehabilitation ward of our hospital included shortening of the number of days between onset and admission, duration of hospitalization, increased transfer to other departments, and decreased rates of transfer to homecare/discharge to home. These findings indicate the importance of systemic management and team-based approaches for enabling more efficient rehabilitation.