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The purpose of this paper is to examine from the viewpoint of resource utilization the Japanese surgical payment system which was revised in April 2016.

The authors collected data from surgical records in the Teikyo University electronic medical record system from April 1 till September 30, 2016. The authors defined the decision-making unit as a surgeon with the highest academic rank in the surgery. Inputs were defined as the number of medical doctors who assisted surgery, and the time of operation from skin incision to closure. An output was defined as the surgical fee. The authors calculated each surgeon’s efficiency score using output-oriented Charnes–Cooper–Rhodes model of data envelopment analysis. The authors compared the efficiency scores of each surgical specialty using the Kruskal–Wallis and the Steel method.

The authors analyzed 2,558 surgical procedures performed by 109 surgeons. The difference in efficiency scores was significant (p = 0.000). The efficiency score of neurosurgery was significantly greater than obstetrics and gynecology, general surgery, orthopedics, emergency surgery, urology, otolaryngology and plastic surgery (p<0.05).

The authors demonstrated that the surgeons’ efficiency was significantly different among their specialties. This suggests that the Japanese surgical reimbursement scales fail to reflect resource utilization despite the revision in 2016.

The purpose of this paper is to conduct a comprehensive review on the implementation and the effect of Japan's Stress Check Program, a national program to monitor and control workplace psychosocial factors that was initiated in December 2015.

We comprehensively reviewed articles published in Japanese and English, assessed the performance of the Stress Check Program and summarized future challenges. We also discussed the implications for practice.

The available literature presented a scientific basis for the efficiency and validity of predictions using the Brief Job Stress Questionnaire, which is the instrument recommended to screen workers with high stress in the program. No study has verified the effect of the program on workers' mental health by using group analysis of stress check results. There is room for improvement in tools that contribute to identifying workers with high stress and in measures for improving the work environment. The Stress Check Program contrasts with risk management of psychosocial factors at work, widely adopted in European countries as a strategy for improving workers' mental health by focussing on the psychosocial work environment.

Although the effectiveness of the Japanese program needs further evaluation, future developments of the program would provide insight for national policies on psychosocial risks/psychosocial stress at work.

This paper is the first systematic review on the implementation and effects of Japan's Stress Check Program.

The purpose of this paper is to examine the association between outpatient orthopedic surgery costs and Japan’s healthcare facilities using a large-scale Japanese medical claims database.

The authors obtained reimbursement claims data for 8,588 patients who underwent orthopedic surgery between April 1 and September 30, 2014 at 3,347 Japanese healthcare facilities. Regression analysis, using ordinary least squares, examined the association between outpatient orthopedic surgery costs and healthcare facility characteristics. By using surgical fees as proxy for the surgical costs, the authors defined three dependent variables: surgical cost for each outpatient orthopedic surgery; pre- and post-operative cost one month before and after a surgical operation; and total cost for each patient. The authors also defined five independent variables, which capture healthcare facility characteristics and patient-specific factors: bed count; whether healthcare facilities are reimbursed in a diagnosis procedure combination system; patient’s age; sex; and anatomical surgical sites.

The authors analyzed 6,456 outpatient orthopedic surgical cases performed at 3,085 healthcare facilities. There were significant differences in the surgical costs for outpatient orthopedic surgery among different healthcare facilities by total beds (p=0.000). Multivariate regression analysis shows that surgical costs for outpatient orthopedic surgery are positively and significantly associated with healthcare facilities classified by total beds after adjusting for patient-specific characteristics (p<0.05).

This is the first research to examine the association between costs for outpatient orthopedic surgery and healthcare facility characteristics in Japan. This study via the multivariate regression method showed that outpatient orthopedic surgery is likely to cost higher as healthcare facility size increased. The average incremental costs for each outpatient orthopedic surgery per 100 beds were calculated at $48.5 for surgery, $40.7 for pre- and post-operative care, and $89.2 total cost.

The sustainability of the Japanese healthcare system is in question because the government has had a huge fiscal debt. Despite an enormous effort to cut the deficit, our healthcare expenditure is increasing every year because of the rapidly aging population. One of the solutions for this problem is to improve the productivity of healthcare. The purpose of this paper is to determine the factors that change surgeons’ productivity in one year.

The authors collected data of all surgical procedures performed at Teikyo University Hospital from April 1 through September 30 in 2014 and 2015, and computed the surgeons’ Malmquist index (MI), efficiency change (EC) and technical change (TC) using non-radial and non-oriented Malmquist model under the constant returns-to-scale assumptions. The authors then divided the surgeons into two groups; one whose productivity progressed and the other whose productivity regressed. These two groups were compared to identify factors that may influence their MI.

The only significant difference between the two groups was ECs (p < 0.0001). The other factors, such as TC, experience, surgical volume, emergency cases, surgical specialty, academic ranks, medical schools and gender, were not significantly different between the two groups.

EC is a major determinant of surgeons’ productivity change. The best way to improve surgeons’ productivity may be to enhance their efficiency regardless of their surgical volume and personal backgrounds.

The cell‐based method of domain decomposition was first introduced for complex 3D geometries. To further assess the method, the aim is to carry out flow simulation in rectangular ducts to compare the known analytical solutions.

The method is not based on equal subvolumes but on equal numbers of active cells. The variables of the simulation are stored in ordered 1D arrays to replace the conventional 3D arrays, and the domain decomposition of the complex 3D problems therefore becomes 1D. Finally, the 3D results can be recovered using a coordinate matrix. Through the flow simulation in the rectangular ducts how the algorithm of the domain decompositions works was illustrated clearly, and the numerical solution was compared with the exact solutions.

The cell‐based method can find the subdomain interfaces successfully. The parallelization based on the algorithm does not cause additional errors. The numerical results agree well with the exact solutions. Furthermore, the results of the parallelization show again that domains of 3D geometries can be decomposed automatically without inducing load imbalances.

Although, the approach is illustrated with lattice Boltzmann method, it is also applicable to other numerical methods in fluid dynamics and molecular dynamics.

Unlike the existing methods, the cell‐based method performs the load balance first based on the total number of fluid cells and then decomposes the domain into a number of groups (or subdomains). Thus, the task of the cell‐based method is to recover the interface rather than to balance the load as in the traditional methods. This work has examined the celled‐based method for the flow in rectangular ducts. The benchmark test confirms that the cell‐based domain decomposition is reliable and convenient in comparison with the well‐known exact solutions.

The purpose of this paper is to examine whether the current surgical reimbursement system in Japan reflects resource utilization after the revision of fee schedule in 2014.

The authors collected data from all the surgical procedures performed at Teikyo University Hospital from April 1 through September 30, 2014. The authors defined the decision-making unit as a surgeon with the highest academic rank in the surgery. Inputs were defined as the number of medical doctors who assisted surgery, and the time of operation from skin incision to closure. An output was defined as the surgical fee. The authors calculated surgeons’ efficiency scores using data envelopment analysis.

The efficiency scores of each surgical specialty were significantly different (p=0.000).

This result demonstrates that the Japanese surgical reimbursement scales still fail to reflect resource utilization despite the revision of surgical fee schedule.

This study aims to examine the environmental attributes relevant to older people's preferences for neighbourhood open spaces. It also aims to explore the association between the relative importance of different environmental attributes and personal and social characteristics in a sample of older people covering a range of geographic locations in the UK.

Choice‐based conjoint analysis (CBC) was used to obtain responses from a sample of 237 older people (60 years +) living in the UK. A total of 13 environmental attributes were identified from earlier qualitative and quantitative studies. Participants were asked to choose a preferred park from a pair of hypothetical neighbourhood parks differing on four of the attributes presented in a questionnaire. The questionnaire included 14 such tasks.

The results suggest that older people preferred a neighbourhood park which is without nuisance, has cafes and toilets, many trees and plants, light traffic en route, wildlife to watch, and is well maintained. Analyses also reveal that whether or not people live alone, and their functional capabilities in getting around, make a difference in the way they place importance on attributes.

The findings can assist those involved in designing and managing outdoor environments to identify salient environmental attributes and prioritise interventions aimed at improving access to, and use of, outdoor spaces for older adults. The approach aids understanding of what is likely to maximise preference and use of open spaces in different segments of the older population.

Conjoint analysis procedures are some of the best tools available for determining importance or relative value of attributes of complex environments from the user point of view. The CBC analysis has been employed for the first time in this study to explore the relative importance of such attributes of open spaces for older adults.

The efficient use of organizational resources is integral to the existence of prime firms. This study, using Malmquist data envelopment analysis (DEA), aims to assess in the level of operational and financial efficiency and its determinants for ensuring and sustaining excellent performance in 33 Egyptian private hospitals.

This study adopted a Malmquist DEA approach to assess the changes in operational and financial efficiency in Egyptian hospitals. Tobit regression was also used to identify the significant variables affecting their efficiency. In addition, a sensitivity analysis is carried out for model validations.

Out of 33 hospitals, 17 were found inefficient due to the decline in their technical efficiency. Moreover, the total value of the software programs and operational expenses and the total number of employees are common factors affecting both operational and financial efficiency. In addition, the number of physicians significantly affects the hospital's financial efficiency.

The study sheds light on the value of using DEA to assess efficiency. DEA in the context of emerging economy such as Egypt's can be a useful tool for decision-makers and practitioners in identifying and addressing performance weaknesses and thus supports continuous improvement in performance.

Several studies have adopted the DEA approach to assess the overall efficiency of hospitals in Europe and the United States. However, in the MENA region, these studies are uncommon. This study is thought to be one of the earliest attempts to assess hospitals' efficiency in Egypt.