社会保障会議 「節度ある医療」へ議論深めよ

The Yomiuri Shimbun April 24, 2013
Panel should deepen discussions for cost-effective medical system
社会保障会議　「節度ある医療」へ議論深めよ（4月23日付・読売社説）

With Japan facing a so-called super-aged society, the government must arrest sharply increasing expenses of medical and nursing care services and establish a reliable social security system.
　超高齢社会を迎える中で、急増する医療・介護費用の伸びを抑え、信頼される社会保障制度を築くことが急務である。

The National Council on Social Security System Reform, a government panel discussing this issue, has compiled a number of points regarding reform of medical and nursing care services.
　その方策を議論している政府の社会保障制度改革国民会議が、医療・介護について改革の論点をまとめた。

The panel described medical facilities and staff, which are not unlimited, as "assets of the people," and underlined the importance of their proper use. We consider the panel's views reasonable for building sustainable medical and nursing care systems.
　限りある医療の設備や人材について「国民の財産」と位置付け、適正利用の重要性を強調した。持続可能な医療・介護制度を構築する上で適切な指摘である。

The point the panel made was that medical services should be altered to allow patients to "receive proper treatment when needed at a proper place and at a minimum cost."
　ポイントは、国民会議が「必要な時に適切な医療を適切な場所で、最小の費用で受ける」医療への転換を打ち出したことだ。

'Free access' to hospitals

At present, Japan's medical services allow patients to have "free access," meaning that a patient can visit any medical institution at any time without worrying too much about payments.
　日本の医療は、患者側が費用の心配をせずに、いつでも、どの医療機関にもかかれる「フリーアクセス」を特徴としている。

This system has brought about a situation that can be described as chaotic, as patients even visit university hospitals when they have a slight cold. As a result, many doctors are overworked.
　その結果、軽い風邪でも大学病院にかかるなど、無秩序とも言える受診を招いた。これが医師の過重労働にもつながっている。

To rectify the situation, the panel proposed that patients be charged about 10,000 yen if they seek treatment at major hospitals without a referral letter, in addition to regular charges for treatment they receive. The extra charge would not be covered by health insurance.
　こうした状況の改善策として、国民会議では、紹介状を持たずに大病院を受診する場合、診察料に加え、１万円程度の保険外の負担を求めるとの案が示された。

This would sharply increase the financial burden patients would have to shoulder. We consider it well worth considering.
自己負担を大幅に引き上げるものだ。検討に値するのではないか。

Among items discussed, the panel said wider use of generic drugs should be realized as soon as possible, as they are cheaper than their original versions.
　国民会議が示した論点のうち、実現を急ぐべきなのは、価格の安いジェネリック医薬品（後発品）の普及である。

In the United States, Britain and Germany, generic products account for 60 percent to 70 percent of all prescribed drugs. In Japan, the figure is about 40 percent.
　米国、イギリス、ドイツでは、処方薬のうち後発品が占める割合が６～７割に上る。これに対し、日本は４割にとどまる。

The low usage of generic drugs in this country can be ascribed to deep-seated doubts doctors have of their efficacy, although their quality has improved.
　後発品の品質は向上しているが、医師の間では、その効能を疑問視する風潮が根強いことも背景にあるだろう。

Generic drugs are priced at 20 percent to 70 percent of the original products. If generic drugs are used more widely, medical spending will be reduced.
後発品の価格は先発品の２～７割で、普及が進めば医療費の削減につながる。

Regarding prescriptions, which are currently left to the discretion of medical institutions, the Health, Labor and Welfare Ministry should consider a system in which generic drugs are the main types of medication prescribed.
　現在は医療機関の裁量に任されている医薬品の処方について、厚生労働省は後発品の使用を原則とする仕組みを検討すべきだ。

Treatment at home

The panel also called for an improvement in health and nursing care services at home by suggesting that patients be cured and supported in local communities, rather than relying on hospitals to provide medical treatment.
　国民会議は、「病院で治す」医療から「地域全体で治し、支える」医療への転換をうたい、在宅医療・介護の充実も求めた。

The panel said prefectural governments should take over the national health insurance program, which deals mainly with self-employed people and is currently operated by municipal governments. This position is reasonable as the panel took into account a number of municipalities in which insurance premiums have sharply risen as fiscal conditions have worsened.
　国民健康保険については、運営主体を現在の市町村から都道府県に広域化する方向で一致した。財政事情が悪化し、保険料が高騰している市町村もあることを踏まえた問題提起だ。

However, it is necessary to discuss these issues from various angles to realize the envisaged measures. The panel is expected to wrap up its discussions by August, as stipulated in a law on integrated reform of social security and tax systems. It is vital for the panel to determine priorities and reach viable conclusions.
　ただ、こうした施策を実現するには様々な角度からの議論が必要だ。国民会議は、社会保障と税の一体改革関連法により、８月までに議論をまとめることになっている。優先順位を決め、実効性ある結論を得ることが肝要である。

(From The Yomiuri Shimbun, April 23, 2013)
（2013年4月23日01時26分  読売新聞）