OBJECTIVES:  Ministry of Health, Labour and Welfare of Japan revises medical fee schedule biennially. The revision is performed in line with the government’s budget policy at national level. The revision also has another role to manage the medical provision system according to the policy. In this study, we analysed how the management strategy in National Hospital Organization (NHO) hospitals was affected by the revision. METHODS: The financial statements, the number of hospital beds and the number of staffs of all 143 NHO hospitals from 2004 to 2014 were obtained to explore the changes in their management conditions. We analysed them with total health expenditures and the revision rates of the medical fee schedule obtained from the government websites. RESULTS: The medical fee schedule was reduced by 3.16% in 2006 and 0.82% in 2008, and then increased by 0.19% in 2010, 0.004% in 2012 and 0.1% in 2014. But the hospitalization fee, especially for patients with severe condition who might have had an operation, had been maintained or increased. In NHO hospitals, the nursing standing order had been increased in general. Over 90% of the acute phase hospitals that have over 350 beds introduced the highest nursing standing order and personnel cost to maintain one bed per day was increased from 190 euro in 2004 to 294 euro in 2014. In addition, these hospitals had continuously increased the medical income per bed in this period. On the other hand, some of the chronic phase hospitals that offer care-mix medical care got higher nursing standing order, though they got only 36% of the highest one, while others were kept in lower nursing standing order. CONCLUSIONS:

In Japan, the government has been well controlling hospitals and their functions through the revision of medical fee schedule in consonance with its policy.