Analysis of hospital charges for ischemic stroke in Fukuoka, Japan

Objectives: Stroke is a heavy economic burden on individuals, society, and health services in Japan, where health expenditures are rising rapidly. The objective of the present study was to examine medical services and demographic factors associated with increased inpatient charges for ischemic stroke in Japan. Subjects and methods: The study subjects were 316 patients with a principal diagnosis of acute ischemic stroke who were discharged from the National Kyushu Medical Center Hospital from 1 July 1995 through 31 June 1999. Demographic, clinical, and administrative data were retrospectively collected from medical records and the hospital Clinical Financial Information System (CFIS). The influence of social and medical factors on total charges was analyzed using the stepwise multiple regression model. Results: Among the total subjects, the mean (median) length of hospital stay (LOHS) was 33 (30) days (range, 2–155 days). The mean (median) hospital charge per patient was US $9020 ($7974) with a range of $336–54 509. The distribution of charges was 42% for fundamental, 17% for injection therapies, 13% for radiological test, 11% for other laboratory examinations, 3% for drugs, and 3% for operations. Stepwise multiple regression analysis revealed that LOHS was the key determinant of the hospital charge (partial R 2=0.5993, P=0.0001). Operations ( P=0.0001) and angiography ( P=0.03) were also independent but less contributory determinants of the hospital charge. Conclusions: LOHS was strongly, positively associated with inpatient charges for ischemic stroke in Japan. This implies that significant charge reductions are more likely to rely on shortening LOHS, which probably can be achieved by altering reimbursement policies.