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.
　高齢化で膨らむ医療費の抑制は、社会保障制度を維持する上で欠かせない。診療報酬のマイナス改定はやむを得まい。

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.
　２０１６年度の診療報酬改定で、政府は全体として０・８４％引き下げることを決めた。前回１４年度改定はプラス０・１％だったが、消費増税の対応分を除けばマイナス１・２６％だった。実質的に２回連続の引き下げだ。

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.
　今回、医師らの技術料である「本体部分」を０・４９％引き上げる一方、医薬品の価格である「薬価部分」は、実勢価格に合わせて１・３３％引き下げる。

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.
　政府は、財政健全化に向けて全体のマイナス改定を早々に決め、本体部分への切り込みも検討してきた。日本医師会などは、医療崩壊を招きかねないとして、プラス改定を強く求めてきた。

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.
　来年夏の参院選を前に、政府・与党が医療機関側に配慮する形で決着したとの見方もある。

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.
　前回の実質マイナス改定以降、病院経営は悪化傾向にある。地方の医師不足も依然として深刻だ。医療従事者の人件費となる本体部分の引き上げは、地域医療を守り、国民の不安を和らげるためには、必要な措置と言えよう。

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.
　報酬改定と同時に、薬剤費抑制のための制度改革を実施する。国内での売り上げが年１０００億円を超えたヒット新薬の値下げや、医師が処方する湿布の枚数制限などが見込まれている。

Use of less costly generic medicines must also be accelerated.
　安価なジェネリック医薬品（後発薬）の利用促進も急ぎたい。

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.
　薬局に支払われる報酬も大幅に見直す。患者の服薬情報を一元管理する「かかりつけ薬局」の普及を促すため、大病院周辺に立ち並ぶ「門前薬局」の報酬は減額する。もうけ過ぎとの批判が強いことを受けたものだ。

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.
　診療行為ごとの報酬の具体的な配分は、年明けに議論される。超高齢社会に適した医療提供体制を構築する。費用を抑えつつ、医療の質を向上させる。こうした方向性に沿ったメリハリのある配分にすることが重要である。

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.
　都道府県では、将来の医療ニーズと必要な病床数を盛り込んだ地域医療構想の策定を進めている。高コストの急性期向け病床を減らし、退院支援や在宅診療などを充実させるのが狙いだ。

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.
　急性期病床が増えすぎ、症状の安定した高齢患者が多数入院している現状は改める必要がある。

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.
　高齢者が地域で安心して暮らせるよう、医療と介護の連携強化も大切だ。報酬配分で重点課題とすべきである。

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