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2009年8月 5日 (水)

介護認定混乱―利用者と現場の声を聞け

--The Asahi Shimbun, Aug. 4(IHT/Asahi: August 5,2009)
EDITORIAL: Nursing-care system
介護認定混乱―利用者と現場の声を聞け

Have Ministry of Health, Labor and Welfare bureaucrats learned anything from the confusion over the medical insurance system for elderly people aged 75 and older? We cannot help but wonder, looking at the current situation.
 後期高齢者医療制度の混乱から、厚生労働省の人々は何を学んだのだろうか。そう言いたくなる事態だ。

Before they can receive nursing-care services under the public insurance scheme, all applicants must be screened and ranked according to how much care they need. Even though the standards for certification were just revised in April, the ministry has decided that many of them need revising again.
 介護サービスを受けるのに必要な要介護度の認定基準が、4月に改定したばかりだというのに、多くの項目でまたも修正されることになった。

The April revisions were officially aimed at making the standards easier to understand so that there would be little variance across regions. However, before the revisions were implemented, many care managers and users expressed apprehension that the new standards would lower users' ranks.
 4月の改定は、地域によって認定にばらつきが出ないよう、基準をわかりやすくすることが目的だった。だが、実施前から「新基準だと介護度が軽くなってしまう」と、現場のケアマネジャーや利用者から懸念が出ていた。

When a user's rank is lowered, the insurance benefits paid to cover the service fees are also lowered. Users are understandably worried they will not be able to afford to pay for the services they need.
 要介護度が軽くなると、介護サービスの利用限度額が低くなるので、「必要なサービスが受けられなくなるのでは」という不安も広がった。

When the new standards were put to practice, as predicted many users were ranked lower than previously or were even declared ineligible for services. This happened despite the ministry's previous reassurance that since the opinions of family doctors would be taken into consideration, the revisions would not necessarily result in lowered ranks. It proved not to be the case.
 実施してみたら、やはり介護度が軽くなる人や非該当とされる人の割合が増えた。「主治医の意見書なども考慮するので軽くなるとは限らない」という厚労省の説明も崩れた。

When making the April revisions, the ministry also included exceptions so that users could remain at their same rank, even if judged at a lower rank under the new standards. But that makes screening for certification a meaningless effort, local governments complained. Why bother?
 厚労省は改定時に、仮に要介護度が軽くなっても従来の要介護度のままにする特例もつくった。だが、自治体の現場から「それでは認定審査の意味がない」と不満が噴き出した。

So the ministry now has no choice but to revise the standards again.
 これらの結果、今回の修正に踏み切らざるを得なくなったのだ。

What caused all the confusion is the fact that the ministry forged ahead with the revisions in April without taking time to listen to users and care providers. The ministry also did not examine the situation adequately or make an effort to broadly inform those groups about the revisions.
 こうした混乱の原因は、厚労省が介護の現場や利用者の声をきかず、十分な検証や周知させる努力がないまま基準の見直しを進めたことに尽きる。

Under April's revised standards, persons who need help putting on or taking off their trousers are judged as "needing assistance." However, people who wear adult diapers are categorized as "not in need of assistance." This is obviously wide of the mark. Such discrepancies could have been easily avoided if the ministry asked caregivers to help revise the standards. We urge the ministry to seriously reflect on this point.
 4月の新基準では、ズボンの着脱を手伝ってもらう人は「介助あり」と判定されるのに、おむつの人が「介助なし」になってしまうなど、明らかにおかしな項目もあった。こんなことは、現場の人たちに見直し作業に加わってもらっていれば、防げたはずだ。今後の大きな反省点にしてほしい。

The standards need to be reviewed and revised if necessary. However, in doing so, the ministry must not allow people in dire need of care to have their ranks lowered.
 基準は必要に応じて改定したり修正したりすることは必要だろう。だが、その際に避けなければならないのは、本当に介護が必要なのに要介護度が軽く判定されるような事態を引き起こしてしまうことだ。

The degree of nursing care need should be determined based on factors such as how much time is required for the care. The ministry should continue to examine whether the proposed standards are in line with that standpoint.
 介護の必要度というのは本来、ケアに要する時間などに基づいて決められている。その観点からみて、今回の修正後の基準なら妥当なのかどうか、引き続き検証を続けてほしい。

Behind all the criticism is the ministry's continued efforts to curb rising social security spending. Critics are beginning to suspect that the ministry's efforts back in April were intended more to cut nursing-care expenses than to revise the standards and how they are applied nationwide.
 今度のような批判が出た背景には、厚労省が社会保障費の抑制を進めてきたという事情もある。基準や運用の見直しで、介護の費用をまた抑えようとしているのではないか、と受け止められたのだ。

The nursing insurance system, which is run with a limited budget, has led to various arguments. For example, how much care for less-needy people should be covered by insurance? Also, the system is supported by premiums paid by people aged 40 and older. Should that age bracket be changed?
 介護保険制度をめぐっては、限られた保険財政の中で軽度の人のケアを保険でどこまでカバーするのか、制度の担い手が今のまま40歳以上でいいのかなど、さまざまな議論がある。

The system was inaugurated nine years ago. How can it be operated in a sustainable manner, given that the number of its users will keep increasing? It is time for our political leaders to provide a broader vision of future welfare care.
 実施から9年。ますます利用者が増える制度をどう安定させるのか。政治が広い視野から道筋を示す時だ。

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