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2008年10月25日 (土)

2025の医療費

2008/10/25 --The Asahi Shimbun, Oct. 24(IHT/Asahi: October 25,2008)

EDITORIAL: Social security expenses

医療費の推計―負担増へ工程表を示せ

      

The national council on social security, an advisory panel to the prime minister, on Thursday publicized its forecast of medical and nursing care expenses in 2025 and estimates of revenues needed to cover them.

 政府の社会保障国民会議が、2025年に予想される医療・介護費と、それをまかなうのに必要な財源の推計を公表した。 

The report calls for a drastic increase in the number of hospital doctors and staff, the doubling of nursing facilities and group homes from the current level and improvements in the quality of medical and nursing care. As the aging of society advances, more money will be needed for health care.

The report estimates that an additional 14 trillion yen in public funds would be needed to cover such expenses. If the increased cost is to be covered by revenues from the consumption tax, a rate hike by 4 percentage points is needed, according to the report.

 病院の医師や職員を大幅に増やし、介護施設やグループホームを今の倍にして、医療と介護の質を高める。お年寄りの増加に伴って膨らむ費用を加えると、約14兆円の新たな公費負担、消費税に換算して4%の引き上げが必要になる、といった内容だ。 

Traditionally, estimates of medical expenses tended to focus mainly on future prospects based on past trends and demographic changes, as well as how to curb expected growth in the expenses.

 これまで医療費の推計といえば、過去の医療費の傾向や人口の変化をもとにした将来予測と、それをどうやって抑えるかが議論の中心だった。 

This time, the panel turned its attention to how medical and nursing care systems should be and what services will be needed. We welcome this major shift from past policies that focused only on curbing expenses.

 今回、望ましい医療や介護の姿、必要なサービスに目を向け始めたことは、抑制一辺倒だった政策を改める新たな芽として歓迎したい。 

Of course, the recently released estimates also took into account measures to check medical expenses. In exchange for reinforcing medical personnel at hospitals and strengthening rehabilitation functions, the report calls for halving hospital stays, which now stand at an average of 20 days.

The proposal is based on the assumption that the trend to shift emphasis from medicine to nursing and from care at facilities to care at home will be further promoted.

 もちろん、今回の推計にも医療費の抑制策は織り込まれている。一般病院での治療に手厚く人を配置してリハビリに力を入れる代わりに、今は平均で20日の入院期間を半分ほどに縮める。医療から介護へ、施設から在宅へ、という流れをさらに推し進めることが前提になっている。 

Even with such restrictive measures, the council estimates that total medical and nursing care expenses would go up to 91 trillion to 94 trillion yen in 2025, requiring public funds to cover 30 trillion yen of the total.

 そうした抑制策をとってもなお、医療・介護費は最低限これだけ膨らむということだろう。 

The latest estimates do not include the proposal by the government and ruling parties to re-examine the newly introduced health-care insurance system designed for people 75 or older. Depending on the content of the revision, it is possible that more public funds will be needed.

 今回の推計には、政府・与党が言い出した後期高齢者医療制度の見直しのことは入っていない。見直しの内容しだいでは、さらに公費を投入しなければならないこともあるだろう。 

According to the estimates, an additional 12 trillion yen would be needed in health and nursing insurance premiums. Although it is unclear which age groups would be required to shoulder how much, there are limits on hiking insurance premiums. Again, an injection of public funds may be needed to curb the increase in premiums.

 推計では、新たに必要となる保険料は12兆円だ。どの世代がどのくらい負担するのかははっきりしないが、保険料の引き上げには限度がある。保険料の上昇を抑えるために、ここでも公費の投入が必要になるかもしれない。 

Given these factors, we cannot help but worry whether a 4-percentage-point increase in the consumption tax rate can really meet swelling medical and nursing expenses. But the biggest problem is the report offers no clues on how to come up with the money.

 そう考えていくと、本当に消費税4%分の引き上げで医療・介護費の増加をまかなえるのか、心配になる。 

 だが、何より問題は財源をひねり出す道筋がはっきり見えないことだ。 

Prime Minister Taro Aso appointed council chairman Hiroshi Yoshikawa, a University of Tokyo economics professor at the Graduate School of Economics, as a private-sector member of another key panel, the Council on Economic and Fiscal Policy.

By doing so, Aso aims to advance the argument for social security issues and tax and fiscal reforms as one. Meanwhile, however, he has also indicated he would not raise the consumption tax rate for three years based on his belief that it would take three years for the nation's economy to fully recover.

 麻生首相は、国民会議座長の吉川洋・東大大学院教授を経済財政諮問会議の民間議員に据えた。社会保障と税財政の改革の議論を一体で進めるという。ところが一方で、「日本経済は全治3年」として、3年間は消費税を引き上げない考えを示している。 

We understand how difficult it is to seek public approval for requiring citizens to immediately shoulder a heavier burden under the current economic situation. But avoiding the issue does not solve the problem.

The government should at least show a future vision of the social security system and present a concrete plan on how to financially achieve the stated goal. The same goes for opposition Minshuto (Democratic Party of Japan).

 今の経済情勢のもとで、ただちに国民に負担増を求めることが難しい事情もわかる。だが、国民の安心を言うならば、社会保障の将来像とともに、どのように財源を裏付けていくのか、具体的な工程表を示すべきだ。そのことは政権を奪おうとしている民主党にも求められている。 

In advancing the policies, the government must also not forget to deal with the shortage of doctors and nursing care providers, which is already starting to affect everyday life. If it only speaks about future visions without properly dealing with the problem, it lacks persuasiveness.

 もちろん、その際には、すでに足元で広がっている医師や介護の担い手の不足への対応も忘れてはならない。そこをおろそかにして、将来のビジョンだけを語っても、説得力に欠ける。 

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