診療報酬改定 地域医療を守る視点が重要だ

The Yomiuri Shimbun
Protecting community medical care crucial in revision of fee schedules
診療報酬改定 地域医療を守る視点が重要だ

Reining in medical care expenses, which have been swelling with the aging of society, is indispensable in order to maintain the social welfare system. To this end, reducing overall medical treatment fees paid to medical institutions under the public health insurance system is unavoidable.

In the revision of such fees for fiscal 2016, the government has decided on a 0.84 percent reduction in total. The previous revision of fiscal 2014 called for an increase of 0.1 percent, but it represented a decrease of 1.26 percent if the hike in the consumption tax is excluded. Therefore, the latest revision means medical treatment fees will have been virtually cut for the second time in a row.

The latest revision calls for raising technical fees for doctors and other health professionals by 0.49 percent and lowering the fees paid for pharmaceuticals by 1.33 percent in accordance with market prices.

After deciding early on to reduce all medical treatment fees with a view to putting fiscal conditions on a sound footing, the government had looked into the possibility of also cutting the technical fees, the main portion of the fees. However, the Japan Medical Association and other organizations strongly asked for an upward revision arguing that a reduction might cause the medical care system to collapse.

Some people point out that the revision was decided in consideration of medical institutions ahead of the House of Councillors election set for next summer.

Since the previous virtual reduction of medical treatment fees, hospital management has been on the trend of deterioration. At the same time, the doctor shortage in local areas remains serious. Raising the main portion of fees, which covers personnel expenses for those engaged in medical practice, can be regarded as a necessary measure to protect community medical service and alleviate the people’s anxiety.

Drug expenses to be curbed

Simultaneously with the revision of medical treatment fees, the government will carry out institutional reform to curb pharmaceutical expenses. The reform calls for, among other things, lowering the prices of newly developed popular drugs that exceeded ¥100 billion in annual sales and limiting the amount of compresses prescribed by doctors.

Use of less costly generic medicines must also be accelerated.

Fees to be paid to drugstores will also be reexamined. To help promote the spread of “regular pharmacies” that use unified management of patient’s drug information, the fees paid to pharmacies located near major hospitals will be reduced. This measure was taken in response to strong criticism that they are making too much profit.

Allocation of fees for each medical treatment will be discussed early next year. A medical care system must be built to meet the needs of a super-aging society. It is imperative to allocate fees in the order of priority to promote the quality of medical treatment while reining in expenses.

Prefectural governments are drawing up community medical service plans that incorporate future needs for medical treatment and the number of beds needed. The plans are aimed at decreasing the number of costly beds for patients requiring acute treatment and improving support for discharge from hospitals and treatment at home.

It is necessary to correct the situation in which elderly patients whose conditions are stable are being hospitalized in great numbers because the number of beds for acute patients has increased excessively.

Strengthening the collaboration between medical treatment and nursing care is also important to make it possible for senior citizens to live at peace in the community. This should be treated as a priority in the allocation of the medical treatment fees.

(From The Yomiuri Shimbun, Dec. 22, 2015)

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