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The inpatient DPC package payment system lowers national insurance reimbursement as compared to the former fee-for-service payment system for inpatients, when an inpatient with hyperthyroidism or toxic multinodular goiter (TMNG) is admitted for 2-day radioiodine therapy. The differentials are 29,970 yen and 48,870 yen for a 2-day hospital stay for administration of 555 MBq and 925 MBq, respectively. We request the Health and Labor Ministry to newly establish the fee for 131I internal therapy for hyperthyroidism. Furthermore, the fee should be paid according to the fee-for-service payment system.

A home hospice care program was begun at Fukushima Rousai Hospital in 1987. Nowadays, fifty percent or more of patients who die of cancer use this program, and patients who die in their own homes have reached about 40 percent. Based on our experience, we analyzed the factors in why home hospice care is not widespread in Japan, and pointed out some factors as follows. The main factors are insufficient disclosure of information regarding diagnosis and disease progression, poor palliative care, and incompleteness of the visit medical treatment system. Other factors are doctors' zeal for cure, patients' and/or families' excessive expectation of recovery, insufficient numbers of doctors and nurses with knowledge and skills concerning the home hospice care, doctors' and/or families' conviction that death in the hospital is natural, lack of social systems that support the family, limitations in the use of medicine at insurance drugstores, and the fact that insurance cannot be adjusted for medical treatment in the patients' home.

Until now there have been three diagnostic tests, prostate specific antigen (PSA, total PSA), gamma-seminoprotein (gamma-Sm), and prostate acid phosphatase (PAP), for prostate cancer. Recent progresses in utilization of PSA has resulted in two advanced tests, PSA-alpha 1 antichymotrypsin complex (PSA-ACT) and free PSA/total PSA ratio. Payment of each test ranges from 210 to 320 yen. The same as for other cancer tests, three tests is paid 440 yen, and four or more is paid 590 yen. To determine the cost effective choice, it is necessary to consult with appropriate urologists.

Purpose: The purpose of this study was to investigate the resource based relative values of visiting nursing services, and to analyze the relationships between the relative values and the dimensions of nursing service(time, mental effort and physical effort)., Methods: We interviewed nurses at 20 Home-visit nursing care stations (HVNCS) in the Metropolitan area using the resource based relative value questionnaires. We asked nurses about relative values of "Total Work", and also measured relative weight of 3 dimensions of nursing services. Total Work was defined as comprehensive evaluation of nursing services, with careful consideration of intensity as well as duration. With the dependent variable as Total Work and independent variables as the 3 dimensions, multiple regression analyses were carried out. Furthermore we examined the degree of influence on Total Work by service type and individual respondent. To examine the validity of the results, we timed nursing services and compared the measured time with the answered time., Results: The 107 respondents were all female and their average age was 36.6 years old. They had HVNCS experience of 2.2 years and 95.3% nurses had experience of hospital nursing. "Total Work" and 3 dimension scores were standardized using common logarithms. "Total Work" of every service significantly differed among service types. The 3 dimensions explained 54.6% of Total Work in the multiple regression analysis. Service type explained 3.3% of Total Work. Individual respondent explained 16.0% of Total Work. Answered time and measured time were not significantly different with nursing services., Conclusions: Although Total Work was somewhat influenced by individual respondent, most of variation was explained by 3 dimensions. Thus, it could be concluded that Total Work is an index of nursing resource input. A further investigation about influence of patients' condition on Total Work is necessary in the future.