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Introduction <p>Timely surgical intervention for hip fractures is essential for improving outcomes in older adults. Japan’s Ministry of Health, Labour and Welfare (MHLW) recently introduced a reimbursement policy to incentivize hip fracture surgery within 48&#xa0;h. However, the impact and sustainability of this policy remain unclear.</p> Materials and methods <p>This retrospective cohort study included 498 patients aged ≥ 75&#xa0;years with hip fractures at a single Japanese hospital from 2022 (pre-policy) to 2024 (post-policy year 2). We performed univariate and multivariate logistic regression analyses of the rate of early surgery (≤ 48&#xa0;h) to identify predictors of surgical delay.</p> Results <p>The early surgery rate rose from 42.4% in 2022 to 52.7% in 2023 but declined to 45.1% in 2024. The reimbursement policy was associated with reduced surgical delay in its first year (2023; OR = 0.58, <i>p</i> = 0.024), but this effect was not sustained. Key structural and clinical&#xa0;predictors of delay included nursing home residence, refusal at other hospitals, weekend admission, and multi-specialty consultation. The frequency of off-hours surgery decreased in 2024, possibly due to the ‘Workstyle Reform for Physicians’ policy. Interaction analysis showed a suggestive inverse effect of off-hours surgery on delay.</p> Conclusion <p>Japan’s reimbursement policy was initially effective, but its impact was transient and ultimately reversed by the competing national workstyle reform policy. Our findings underscore that to achieve sustained improvements in timely surgical care, future strategies must&#xa0;not only&#xa0;ensure coordinated policy design but also address persistent structural barriers, including weekend service gaps and fragmented regional coordination.</p>

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Three-year trends in early hip fracture surgery surrounding a national reimbursement policy in Japan

  • 期刊论文

  • 发表日期：

    2025年10月1日

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  • Yukihiro Kokubu,
  • Aya Obi,
  • Yuka Kimura,
  • Aya Hattori,
  • Hisanori Nemoto,
  • Yujiro Matsuda,
  • Yuho Oki,
  • Ryo Amamiya,
  • Keita Ogine,
  • Masaru Misawa,
  • Tomoko Shimaoka,
  • Keisuke Hirose,
  • Yoshiaki Ando,
  • Toshinori Kurashige,
  • Kiyoma Marusugi,
  • Shuichi Kaneyama,
  • Hiroshi Kawaguchi

摘要

Introduction

Timely surgical intervention for hip fractures is essential for improving outcomes in older adults. Japan’s Ministry of Health, Labour and Welfare (MHLW) recently introduced a reimbursement policy to incentivize hip fracture surgery within 48 h. However, the impact and sustainability of this policy remain unclear.

Materials and methods

This retrospective cohort study included 498 patients aged ≥ 75 years with hip fractures at a single Japanese hospital from 2022 (pre-policy) to 2024 (post-policy year 2). We performed univariate and multivariate logistic regression analyses of the rate of early surgery (≤ 48 h) to identify predictors of surgical delay.

Results

The early surgery rate rose from 42.4% in 2022 to 52.7% in 2023 but declined to 45.1% in 2024. The reimbursement policy was associated with reduced surgical delay in its first year (2023; OR = 0.58, p = 0.024), but this effect was not sustained. Key structural and clinical predictors of delay included nursing home residence, refusal at other hospitals, weekend admission, and multi-specialty consultation. The frequency of off-hours surgery decreased in 2024, possibly due to the ‘Workstyle Reform for Physicians’ policy. Interaction analysis showed a suggestive inverse effect of off-hours surgery on delay.

Conclusion

Japan’s reimbursement policy was initially effective, but its impact was transient and ultimately reversed by the competing national workstyle reform policy. Our findings underscore that to achieve sustained improvements in timely surgical care, future strategies must not only ensure coordinated policy design but also address persistent structural barriers, including weekend service gaps and fragmented regional coordination.