Local complications in head and neck surgery and the diagnosis procedure combination/prospective payment system

The diagnosis procedure combination/prospective payment system (DPC/PPS) that was begun in university hospitals in fiscal 2003 is outlined. The DPC in the 2004 version concerning head and neck cancer was analyzed, and the handling of local complications in postoperative head and neck surgery patients in the DPC/PPS was examined. If major surgery of the head and neck cancer was performed, it often turned out to fall outside the scope of the inclusive evaluation. Moreover, it is understood that the presence of complication is not reflected in the classification in head and neck cancer even though it is common in other diseases to subdivide the diagnosis group classification by the presence of complication. The problem of local complication was examined in the case of oral cancer treatment by our department in 2004. It was clarified that the decision on whether complication was a negative factor of the DPC/PPS depended on the medical treatment expense concerning complication and the balance of the hospitalization period. Moreover, it seemed that cases which did not have complication and were quickly discharged from hospital were a minus in the DPC/PPS, and so improvement plans are necessary.