Japanese surgeons' productivity change after the revision of surgical fee schedule

The goal of this study is to evaluate Japanese surgeons' productivity change before and after the revision of fee schedule. We focused on the revision of fee schedule that was implemented on April 1, 2014. We analyzed all the surgical procedures performed from April 1 through September 30 in 2013 and 2014 at Teikyo University Hospital. Non-radial and non-oriented Malmquist model under the constant returns-to-scale assumptions was employed. Inputs were defined as the number of medical doctors who assisted surgery, and the time of surgical operation from skin incision to skin closure. The output was defined as the surgical fee for each surgery. We computed each surgeon's natural logarithms of Malmquist index, efficiency change and technical change. We analyzed 5,315 surgical procedures performed by 108 surgeons. The productivity change was not significantly different from 0 (p = 0.230). However, the efficiency change was significantly positive (p = 0.041) while the technical change was significantly negative (p < 0.0001). Surgeons' productivity did not significantly change after the revision of fee schedule because surgeons performed surgery more efficiently to compensate for their reduced reimbursements. (C) 2016 Elsevier Ltd. All rights reserved.