Influence of superstition on the date of hospital discharge and medical cost in Japan: retrospective and descriptive study

BMJ 1998;317:1680-1683 ( 19 December )

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Influence of superstition on the date of hospital discharge and medical cost in Japan: retrospective and descriptive study

Kenji Hira, postgraduate student, ^a Tsuguya Fukui, professor, ^a Akira Endoh, postgraduate student, ^b Mahbubur Rahman, postgraduate student, ^a Munetaka Maekawa, postgraduate student. ^a

^a Department of General Medicine and Clinical Epidemiology, Kyoto University, Sakyo-ku, Kyoto 606-8507, Japan, ^b Graduate School of Human and Environmental Studies, Kyoto University

Correspondence to: Dr Hira ken{at}kuhp.kyoto-u.ac.jp

Objectives: To determine the influence of superstitionabout Taian (a lucky day)-Butsumetsu (an unlucky day) on decisionto leave hospital. To estimate the costs of the effect of thissuperstition.
Design: Retrospective and descriptivestudy.
Setting: University hospital in Kyoto,Japan.
Subjects: Patients who were discharged alive from KyotoUniversity Hospital from 1 April 1992 to 31 March1995.
Main outcome measures: Mean number, age, and hospital stay of patientsdischarged on each day of six daycycle.
Results: The mean number, age, and hospital stay ofdischarged patients were highest on Taian and lowest on Butsumetsu(25.8 v 19.3 patients/day, P=0.0001; 43.9 v 41.4 years, P=0.0001;and 43.1 v 33.3 days, P=0.0001 respectively). The effect of thisdifference on the hospital's costs was estimated to be 7.4 millionyen (£31000).
Conclusion: The superstition influenced the decision toleave hospital, contributing to higher medical care costs in Japan.Although hospital stays need to be kept as short as possible tominimise costs, doctors should not ignore the possible psychologicaleffects on patients' health caused by dismissing thesuperstition.

Key messages

Belief in Taian-Butsumetsu, a superstition relating to the six day lunar calendar, is common among Japanese people
This study showed that the mean number of patients discharged on Taian (a lucky day) is the highest and that on Butsumetsu (an unlucky day) is the lowest
Patients discharged on Taian were older, were more likely to be female, and had longer hospital stays than those discharged on other days
The findings suggest that patients were extending their stay to leave hospital on Taian
This superstitious belief increased the cost of medical care in Japan

© BMJ 1998

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