介護報酬削減 職員の待遇改善と両立させよ

The Yomiuri Shimbun
Balance nursing care fee changes with better conditions for workers
介護報酬削減　職員の待遇改善と両立させよ

To maintain the nation’s social security system in a rapidly aging society, it is vital to curb ever-soaring nursing care expenses.
　超高齢社会で社会保障制度を維持するには、膨張する介護費の伸びの抑制が欠かせない。

The government has decided to cut nursing care service fees under public nursing care insurance by 2.27 percent overall, starting in fiscal 2015. The move is the first downward revision in fees in nine years and the second largest cut on record following reductions of 2.3 percent in fiscal 2003.
　政府は、介護保険サービスの公定価格である介護報酬を２０１５年度から全体で２・２７％引き下げることを決めた。９年ぶりのマイナス改定だ。過去最大だった０３年度の２・３％に次ぐ下げ幅になる。

Nursing care fees are paid to nursing care providers in compensation for the services provided under the public insurance system.
　介護報酬は、提供したサービスの対価として、介護保険から事業者に支払われる。

The total expenses of the nursing care insurance program, which stood at ¥3.6 trillion in fiscal 2000, when the system started, reached ¥10 trillion in fiscal 2014. The expenses are expected to double within the next 10 years.
　スタート時の００年度に３・６兆円だった介護保険の総費用は、１４年度には１０兆円に達した。今後１０年で倍増する見込みだ。

With a 1 percent cut in nursing care fees, total expenses are calculated to be trimmed by ¥100 billion a year. As the planned hike in the consumption tax rate to 10 percent has been postponed by a year and a half and the task of securing revenue sources for social security programs has consequently been delayed, the government will inevitably cut nursing care fees to curb overall expenditures.
　介護報酬を１％下げれば、総費用が年１０００億円減るとされる。消費税率１０％への引き上げが先送りされ、社会保障の財源確保が遅れる中、歳出抑制のために報酬引き下げはやむを得まい。

Meanwhile, the planned cutback will not only ease the government’s fiscal burdens, but also reduce insurance premiums paid by insured and service users.
　引き下げにより、財政負担だけでなく、加入者には支払う保険料が軽減されるメリットもある。

The Finance Ministry had originally demanded that nursing care fees be cut by about 4 percent. But should the business conditions of nursing care providers markedly deteriorate, they may have to lower the quality of their services.
　財務省は４％程度の引き下げを求めていた。ただ、事業者の経営が極端に悪化すればサービスの低下を招きかねない。

Serious manpower shortage

The latest revision can be construed as one resulting from the government taking into account both its fiscal condition and the business operations of service providers.
今回の改定率は、財政状況と事業経営の双方に配慮した結果と言えよう。

With regards to better working conditions for nursing care workers, the government will allot extra fees to nursing care benefits for providers that deal with the issue systematically.
　一方、介護職員の待遇改善に関しては、計画的に取り組む事業者への加算を拡充する。

Manpower shortages have reached serious levels at workplaces of nursing care services, primarily stemming from low salaries. The average monthly wage for nursing care workers is ¥220,000, which is ¥100,000 less than the average across all industries. How appropriate, then, that the government has set aside extra outlays to raise the monthly average wage for nursing care workers by about ¥12,000.
　介護現場では人手不足が深刻化している。最大の原因は待遇の低さだ。平均賃金は月２２万円で、全産業平均より１０万円も少ない。賃金を月１万２０００円程度アップできるよう、別枠で費用を確保したのは適切な措置である。

To ensure the extra outlays will be reflected in wage hikes, public administrators must be adamant in making regular inspections.
　加算分が確実に賃金アップに反映されるよう、行政の厳格なチェックが必要だ。

In fiscal 2025, when members of the baby-boomer generation will be 75 or older, projections indicate the need to increase the number of nursing care workers by 1 million. Nursing care providers need to make great strides to improve the working conditions for nursing care workers.
　団塊の世代が７５歳以上になる２５年度には、介護職員を今より１００万人増やす必要があるとの推計もある。事業者には、さらなる処遇改善の努力が求められる。

The Health, Labor and Welfare Ministry will decide on fees by type for nursing care services in the days ahead. The ministry is planning to increase rewards for at-home services supporting those requiring high or moderate levels of nursing care, as well as at-home services that assist elderly citizens with dementia.
　厚生労働省は今後、個別サービスごとの価格を決める。介護の必要性が高い中重度者や認知症高齢者向けの在宅サービスなどを手厚くする方向だ。

Meanwhile, the government will drastically cut service fees for special elderly homes providing round-the-clock nursing care because operators of such facilities are said to have amassed profits averaging ¥300 million. There are said to be not a few of those operators that have neglected to improve their facilities and working conditions for their employees.
　特別養護老人ホームは、大幅減額になる。平均３億円もの利益を蓄えていることが背景にある。設備や職員の待遇の改善を怠っている施設も少なくない。

Financial conditions differ among service operators. The government would cause more harm than good with these across-the-board cuts in fees if operators that had been striving to improve their services end up in financial hardship.
　経営状況は施設ごとに異なる。報酬の一律カットで、サービス向上に努めてきた施設が経営難に陥っては本末転倒だ。

The ministry needs to work out a framework that accordingly rewards providers offering good services by, for instance, finding ways to enhance the fees paid to them.
　報酬の加算方法を工夫するなど、良質な事業者が報われる仕組みにすることが重要である。

(From The Yomiuri Shimbun, Jan. 14, 2015)