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[How do medical facilities cope with a new medical fee system? A case study of the Kumamoto medical area].

In April 2000, a new medical fee system for hospitals designated for specific functions was introduced into the remuneration of medical services. A basic concept of this system is to pay a supplementary fee for hospital treatment during the acute treatment. In this study, in order to clarify the effect of this new system on hospital management, we performed the case study of three hospitals (Kumamoto National Hospital, Saiseikai Kumamoto Hospital and Kumamoto Chuo Hospital) located in Kumamoto medical area. As a result, in this area, the basic qualitative aspects of medical care environment, such as the number of hospital beds and long-term facilities, was found to be well equipped. In addition, three hospitals differ in following points: 1) characteristics of clinical department, 2) management strategy. In conclusion, the case of the Kumamoto medical area was considered to provide an important model of collaboration and co-operation between medical facilities toward the new medical fee system.