Comparison of price, volume and composition of services provided to inpatients for two procedures between a US and a Japanese academic hospital


Background: To drill down into why per capita health expenditures vary between the US and Japan, this exploratory study compares the price, volume and composition of services provided to inpatients for two procedures in an academic hospital in the US, and one in Japan. Methods: Detailed analysis of the amount reimbursed and services delivered was made from claims data for 449 acute myocardial infarction treated with coronary stents placed by percutaneous coronary intervention (PCI) and 115 heart valve dysfunction with heart valve replacement (HVR) cases in Johns Hopkins Hospital (JHH) Baltimore, Maryland, and 34 PCI and 21 HVR cases in Keio University Hospital (KUH), Tokyo. Results: After making appropriate adjustments, the reimbursed amount per discharge at JHH was significantly higher (Wilcoxon ranksum test, p < 0.01) for both medical conditions. This was due to more use of higher priced technology and higher prices for the same technology at JHH compared with KUH. However, medical imaging was performed more frequently at KUH and the reimbursed amounts per unit for the devices were higher at KUH. Analysis of room and board costs showed that the higher staffing level and wages of nurses at JHH was compensated by its shorter average length of stay for PCI, but not for HVR. Conclusion: Detailed analysis of the reimbursed amount and the utilization of services are needed to understand international variations in healthcare spending.

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Inokuchi, T. , Ikegami, N. , Gupta, V. , Rao, S. and Anderson, G. (2013) Comparison of price, volume and composition of services provided to inpatients for two procedures between a US and a Japanese academic hospital. Health, 5, 703-711. doi: 10.4236/health.2013.54093.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] OECD Health Data (2012)
[2] Danzon, P.M. and Furukawa, M.F. (2008) International prices and availability of pharmaceuticals in 2005. Health Affairs, 27, 221-233. doi:10.1377/hlthaff.27.1.221
[3] Anderson, G.F., Shea, D.G., Hussey, P.S., Keyhani, S. and Zephyrin, L. (2004) Doughnut holes and price controls. Health Affairs, Web Exclusives, W4-396-404. doi:10.1377/hlthaff.w4.396
[4] Busse, R., Schreyögg, J. and Smith, P.C. (2008) Variability in healthcare treatment costs amongst nine EU countries: Results from the Health BASKET project. Health Economics, 17, S1-S8. doi:10.1002/hec.1330
[5] Stargardt, T. (2008) Health service costs in Europe: Cost and reimbursement of primary hip replacement in nine countries. Health Economics, 17, S9-S20. doi:10.1002/hec.1328
[6] Epstein, D., Mason, A. and Manca, A. (2008) The hospital costs of care for stroke in nine European countries. Health Economics, 17, S21-S31. doi:10.1002/hec.1329
[7] Tiemann, O. (2008) Variations in hospitalisation costs for acute myocardial infarction: A comparison across Europe. Health Economics, 17, S33-S45. doi:10.1002/hec.1322
[8] Bellanger, M.M. and Or, Z. (2008) What can we learn from a cross-country comparison of the costs of child delivery? Health Economics, 17, S47-S57. doi:10.1002/hec.1325
[9] Schreyögg, J. (2008) A micro-costing approach to estimating hospital costs for appendectomy in a cross-European context. Health Economics, 17, S59-S69. doi:10.1002/hec.1323
[10] Fattore, G. and Torbica, A. (2008) Cost and reimbursement of cataract surgery in Europe: A cross-country comparison. Health Economics, 17, S71-S82. doi:10.1002/hec.1324
[11] Tan, S.S., Ken Redekop, W. and Rutten, F.F.H. (2008) Costs and prices of single dental fillings in Europe: A micro-costing study. Health Economics, 17, S83-S93. doi:10.1002/hec.1326
[12] Schreyögg, J., Tiemann, O., Stargardt, T. and Busse, R. (2008) Cross-country comparisons of costs: The use of episode-specific transitive purchasing power parities with standardised cost categories. Health Economics, 17, S95- S103. doi:10.1002/hec.1327
[13] Ishikawa, K.B., Holt, M., Kaihara, S., Yoshikawa, A., Hopkins, D.S. and Mason, M. (1993) Performance, characteristics, and case mix in Japanese and American teaching hospitals. Medical Care, 31, 542-551. doi:10.1097/00005650-199306000-00008
[14] Schreyögg, J., Stargardt, T. and Tiemann, O. (2011) Costs and quality of hospitals in different health care systems: A multi-level approach with propensity score matching. Health Economics, 20, 85-100. doi:10.1002/hec.1568
[15] Newhouse, J.P. (1993) An iconoclastic view of health cost containment. Health Affairs, 12, 152-171. doi:10.1377/hlthaff.12.suppl_1.152
[16] Newhouse, J.P. (1992) Medical care costs: How much welfare loss? Journal of Economic Perspectives, 6, 3-21. doi:10.1257/jep.6.3.3
[17] Cutler, D. (1995) Technology, health costs, and the NIH. National Institutes of Health Roundtable on the Economics of Biomedical Research.
[18] Murray, R. (2009) Setting hospital rates to control costs and boost quality: The Maryland experience. Health Affairs, 28, 1395-1405. doi:10.1377/hlthaff.28.5.1395
[19] Ikegami, N. and Anderson, G.F. (2012) In Japan, all-payer rate setting under tight government control has proved to be an effective approach to containing costs. Health Affairs, 31, 1049-1056. doi:10.1377/hlthaff.2011.1037
[20] Ikegami, N. Wolfson, J. and Ishii, T. (1996) Comparison of administrative costs in health care between Japan and the United States. In: Containing Health Care Costs in Japan, University of Michigan Press, Ann Arbor.

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